儿童活体肝部分移植术进展

Development of Living-Related Liver Transplantation for Children

目的 介绍近年来儿童活体肝移植术的进展。方法 以全球活体肝部分移植中心京都大学的资料为重点 ,综述近年来全球儿童活体肝移植术的现状。结果 活体肝移植仍然是儿童患者的首选术式 ,其主要适应证是胆汁淤积性肝病 (80 % ) ,全球最大一组资料 (4 62例 )表明 ,其 1、3、5年累计生存率分别为 79.8%、77.0 %和 77.0 % ,优于同期接受全肝移植的患者 (12 9例 ,1、3、5年累计生存率分别为 76.0 %、70 .0 %和 65 .0 % ) ,且择期手术患者的生存率 (85 .0 % )优于急诊手术者 (67.0 % ) ;死亡原因主要是排斥反应和感染。此外 ,对于儿童患者 ,还开展了原位辅助性活体肝部分移植和再次活体肝移植术。结论 严格选择手术适应证及手术时机和做好术后 1年内的管理是提高远期疗效的关键 ,儿童活体肝部分移植术疗效明显优于成人 ,也优于全肝移植术。

Objective To review the advances of living related liver transplantation for children. Methods On the basis of the data in Kyoto university, the center of living related liver transplantation in the world, the current situation of living related liver transplantation for children were investigated. Results Eighty percent of patients who underwent the living related liver transplantation were children with cholestatic liver disease. From the data of 462 cases, the patients'survival rate for 1, 3 and 5 years after living related liver transplantation (79.8%, 77.0% and 77.0% respectively) preceded the survival rate of 129 patients who underwent the whole liver transplantation (76.0%, 70.0% and 65.0% respectively). To the living related liver transplantation, the survival rate was higher for patients who underwent selective operation (85.0%) than emergency surgery (67.0%). The principal causes of death were rejection and infection. Furthermore, a partial orthotopic liver transplantation and living related liver replantation were performed for children. Conclusion Strict indication, optimal health status and perfect postoperative management are the keys to keep patients long term healthy survival. The curative effect of living related liver transplantation precedes the whole liver transplantation. For children, living related liver transplantation is better than for adults.