同种原位肝移植围手术期的处理

Pevioperative management of attorthotopic liver allo - transplantation

目的 总结我院自1999年8月以来,开展的3例同种异体原位肝移植（Orthotopic livertransplantation,OLT）围手术期的处理过程及经验体会。方法 2例原位肝移植、1例肝-肾联合移植术。均在术前12h口服环孢霉素A（CsA）和骁悉（MAP）,术中用甲基强的松龙（MP）1000 mg静脉冲击防止排斥,术后MP+CsA+MAP三联用药。结果 ①文中3例病人手术均获成功,其中2例原位肝移植病人存活至今,生活质量良好。肝肾联合移植病人于术后第76d死于严重混合感染。②移植肝的功能维护是肝移植术后处理的重点,其中包括急性排斥反应的诊断和处理,以及其它可能引起肝移植肝功能损害、衰竭等问题的处理。③全身非移植器官的功能恢复:包括呼吸系统、感染、出血、胸水、腹水等并发症的处理过程。结论 肝移植围手术期的处理是肝移植成功与否的关键,其中包括肝移植的排斥反应及各系统的功能支持与维护。

Objective Three patients who had been operated with orthotopic liver transplantation (OLT) after Aug. 1999 in our hospital were reviewed to obtain experience about perioperation management, and to investigate the measures on maintanence of important organs, and to diagnose and treat rejection, infections and haemorrhage. Methods Three cases, which included 2 cases of OLT only and 1 case of OLT associated with renal transplantation, were reviewed for special complications in perioperation and management of them. Results (1)Two cases of OLT only had been operated succesfully and survived. One case of OLT associated with renal transplantation died 76 days after operation owing to inflections. (2)It was also important to maintain the functions of liver allografts, and diagnose and treat rejection. It was also important to resolve problems causing damage of liver allografts. ㊣t was also very important to sustain functions of non - allografted organs. Conclusions Treatment of complications perioperation of OLT is very important.