公民逝世后器官捐献15例肝移植临床疗效分析:附视频

Clinical effect analysis of 15 cases of liver transplantation from organ donation after citizen death:video attached

目的探讨公民逝世后器官捐献(CDCD)肝移植的临床疗效及总结经验。方法回顾性分析安徽医科大学第一附属医院2015年2月至2017年11月成功实施的15例CDCD肝移植供、受者临床资料,观察并分析肝移植受者围手术期情况及预后等。结果 15例器官捐献者均符合中国三类捐献标准(C-Ⅲ),采用经典原位全肝肝移植术7例,改良背驮式肝移植术8例,均顺利完成手术,供肝质量544.2~1 422.4(1 171.9±289.6)g,热缺血时间9~22(17.1±3.1)min,冷缺血时间2~9(5.4±2.0)h,无肝期43~100(67.5±14.1)min,术中出血量300~3 000(1 283.3±808.4)ml,手术时间355~605(513.3±70.6)min,术后呼吸支持时间为5~960(93.1±241.7)h,ICU逗留时间为48~720(126±167.9)h,术后住院时间13~103(34.2±22.1)d,总住院费用8.73~54.78万元。术后并发症包括迟发性胆道吻合口狭窄1例,应激性消化道大出血、小肝综合征、多重耐药菌感染、肝性胸水1例,急性排斥反应3例,肺部细菌感染2例,带状疱疹病毒感染2例,腹腔大出血1例,肝包膜下血肿1例,移植肝新发肿瘤1例,拔除T管后胆漏并致弥漫性腹膜炎1例。术后随访时间0.5~51个月,1例因术后出现急性排斥反应、感染导致多器官功能衰竭于术后第27天死亡,1例于出院后174 d因移植肝功能衰竭伴心肺功能衰竭死亡,余13例受者肝功能均恢复顺利,预后良好。结论公民逝世后器官捐献供肝肝移植仍系高风险、高并发症手术,通过不断优化器官捐献操作流程、加强捐献器官功能维护、严格把握移植受者手术指征、规范围手术期管理、术后定期随访,公民逝世后器官捐献供肝可获得良好的临床疗效。

Objective To investigate the clinical effect and experience of liver transplantation from organ donation after citizen death. Methods The clinical data of fifteen donors and recipients who received liver transplantation were retrospectively analyzed from February 2015 to November 2017 in the First Affiliated Hospital of Anhui Medical University. The perioperative condition and prognosis of liver transplant recipients were observed and analyzed. Results The 15 cases of organ donors belonged to the donation after brain and cardiac death（C-Ⅲ）. Using the classical orthotopic liver transplantation in 7 cases and 8 cases of modified piggyback liver transplantation, operation was successfully completed. The quality of donor liver was 544.2-1 422.4（1 171.9±289.6） g, the warm ischemia time was 9-22（17.1±3.1） min, the cold ischemia time was 2-9（5.4±2.0） h, the anhepatic phase was 43-100（67.5±14.1） min, the amount of intraoperative bleeding was 300-3 000（1 283.3 ±808.4） ml, the operation time was 355-605（513.3±70.6） min, the postoperative respiratory support time was 5-960（93.1±241.7） h, ICU stay timewas 48-720（126±167.9） h, postoperative hospitalization time was 13-103（34.2±22.1） d, and the total hospitalization cost of 87.3-547.8 thousand yuan. The postoperative complications included delayed biliary anastomotic stenosis in 1 case, 1 case of upper gastrointestinal bleeding, small liver syndrome, multidrug resistant bacteria infection, hepatic hydrothorax, 3 cases of acute rejection, 2 of pulmonary infection, 2 of herpes zoster virus infection, 1 of abdominal bleeding, 1 of hepatic subcapsular hematoma, 1 of liver transplantation of new tumors, 1 of bile leakage after removal of T tube and 1 case of bile leakage and diffuse peritonitis caused by T tube were removed. Postoperative follow-up time was 0.5-51 months. One case died of multiple organ failure 27 days after operation because of acute rejection and infection after operation, 1 case in 174 days after discharge because of the function of the transplanted liver failure with heart failure death, while more than 13 recipients of liver function recovered smoothly, and the prognosis is good. Conclusions Liver transplantation from donation after citizen death is still of high risks and complications. As with continuous optimization of organ donation procedures, strengthening the function of organ donation recipients maintenance, strictly grasping the surgical indications, perioperative management and regular follow-up, citizens of organ donation after death of donor liver can obtain good clinical curative effect.