人体原位肝移植13例报告

Orthotopic liver transplantation:a report of 13 cases

目的 总结临床肝移植的经验。方法 对 11例原位肝移植与 2例肝、肾联合移植的临床资料进行回顾性分析。结果 全组死亡 5例 ,存活 8例 ,直接死亡原因为脑出血 (3例 )、原发性移植肝无功能 (1例 )和急性排斥反应 (1例 )。术后服用拉米呋啶的 7例均未见乙型肝炎复发。术后发生急性肾功能衰竭、排斥反应、脑血管意外、感染及肝上、肝下下腔静脉吻合口扭曲梗阻等技术或非技术因素所致的并发症。结论 开展肝移植的初期应严格掌握适应证 ,选择条件较好的受者 ;围手术期的严密监测与正确处理、并发症的防治及人工肝的辅助治疗等是肝移植成功的重要条件。

Objective To sum up the clinical experience of liver and combined liver-kidney transplantation. Methods The clinical data of 11 cases of liver transplantation and 2 cases of combined liver-kidney transplantation were analyzed retrospectively from April 1993 to Sep. 1999. Results The complications included acute renal function failure in 5 cases, acute or chronic rejection in 6, intracerebral hametoma in 3, cerebral thrombosis in 1, infection in 10 and outflow stenosis of superior IVC in 1. Five patients died on day 47, day 21, day 11, day 15 and day 24 post-operation respectively. Among them, 3 cases died from intracerebal bleeding, 1 from primary nonfunction of liver graft and 1 from severe acute rejection. Eight patients survived with normal graft function. Conclusions It was necessary to abide to the indications of liver transplant and to select good condition recipients in primary stage of performing liver transplantation. Comprehensive monitoring and correct management, perioperation usage of artificial liver support system and so on are all major factors for success.