原位肝移植加人工肝支持疗法治疗暴发性肝功能衰竭

Treatment of fulminant hepatic failure by liver transplantation plus preoperative artificial liver support system

目的探讨原位肝移植加人工肝支持疗法对暴发性肝功能衰竭的疗效及非生物型人工肝支持系统在暴发性肝功能衰竭肝移植术前准备中的作用。方法本组 7例暴发性肝功能衰竭患者 ,均有不同程度的肝昏迷、黄疸、腹水、肝功能损害 ,出血倾向。在等待供肝的过程中分别接受 2～2 0次非生物型人工肝支持疗法 ,供肝到达后行原位肝移植术。结果人工肝支持治疗后患者血清胆红素明显下降 ,腹水明显减少 ,部分病人肝性脑病有所好转。 7例均顺利行肝移植 ,5例存活 3～ 2 0个月 ,其中 3例已存活 1年半以上 ,并已恢复正常工作 ,2例术前有肝肾综合征者 ,术后 3d死亡 ,其中1例并发急性重症胰腺炎。结论原位肝移植加人工肝支持疗法是暴发性肝功能衰竭的有效方法 ,术前人工肝支持可作为暴发性肝功能衰竭等待供肝期间的桥梁 ,并可改善病情减少肝移植的危险因素。

Objectives To investigate the effects of orthotopic liver transplantation (OLT) plus non-biologic artificial liver support system (NBALSS) on fulminant liver failure(FLF), and efficiency of NBALSS on the preoperative preparation of OLT. Methods Seven FLF patients received OLT after 2 to 20 sessions of NBALSS therapy while waiting donor liver.Results Decreased serum bilirubin, improved hepatic encephalopathy and ascites was achieved in all 7 cases after NBALSS. Five of 7 patients have survived for 3 to 20 months after OLT, of whom 3 have had excellent quality of life for more than 18 months. Two patients died of hepatorenal syndrome or of hepatorenal syndrome and serious pancreatitis. Conclusions OLT plus NBALSS is one of the most effective therapies for FLF, NBALSS can be used to tide the FLF patients over until a donor liver is available.