老年良性终末期肝病患者肝移植的临床特点及疗效

Effect of liver transplantation for benign end-stage liver disease in patients over sixty years of age

目的探讨老年良性终末期肝病患者肝移植的临床特点及术后疗效。方法回顾性分析5年半内收治的同种异体原位肝移植患者的临床资料,对象为原发性良性肝病患者;其中19例为老年组(年龄≥60岁),88例为成年组(18～59岁)。比较两组术前实验室指标,合并症,术中情况,术后并发症及2年生存率。结果与成年组比较,老年组术前合并糖尿病的比例(8/19 vs.14/88),血清肌酐水平[(94.28±25.54)μmol/L vs.(82.51±19.23)μmol/L],ICU治疗时间[(16.4±10.4)vs.(9.1±11.3)d],术后深部真菌感染比例(8/19 vs.14/88)均显著升高(均P<0.05),其2年生存率与成年组比较,无统计学差异(P>0.05)。结论老年肝移植患者与成年组相比,术前合并糖尿病的比例高,肾功能代偿差,ICU治疗时间较长,术后真菌感染率高;术前严格筛选,术后密切监测和脏器支持维护及免疫抑制剂的合理使用,其疗效两者相当。

Objective To investigate the clinical features and outcome of liver transplantation for benign end-stage liver disease in recipients over sixty years of age.Methods From June 2002 to January 2008,the clinical data of patients with benign liver disease who underwent liver transplantation in our department were analysed retrospectively.The aged group consisted of patients ≥60 years（n=19） and the adult group consisted of patients aged between 18 years to 59 years（n=88）.Preoperative laboratory indexes and complications,variables of intra-operation,postoperative complications and 2-year survival rate were compared between the two groups.Results Preoperative diabetes mellitus and the level of serum creatinine,intensive care unit（ICU） length of stay and postoperative deep fungal infection in the aged group were significantly higher than those in adult group（P0.05）.There was no statistically significant difference in 2-year survival rate between the two groups（P0.05）.Conclusions Compared with adult group,aged group has higher incidence of diabetes mellitus,lower renal function reserve preoperatively,and postoperative deep fungal infection.Moreover,with close monitoring of patients in the perioperative period,effective support of vital organs and judicious use of immunosuppressants,the prognosis of elderly patients with benign hepatic disease after liver transplant is comparable to adult recipients.