肝脏移植10年120例经验回顾

Ten year′s experience on liver transplantation in a single organ transplantation center

目的总结近年来我院肝移植的临床经验。方法我院自 1993年至今连续实施的12 0例人体原位肝移植病例 ,其中 1993～ 1997年为第一阶段 (2例 ) ,1999年为第二阶段 (15例 ) ,2 0 0 0年 1月～ 2 0 0 2年 9月为第三阶段 (10 3例 ) ,对手术适应证 ,外科技术 ,围手术期处理以及术后并发症防治等方面经验进行了回顾性总结。结果肝脏恶性病变在第一阶段两例受体均为恶性肿瘤 ,第二阶段为 5 3% (8 15 ) ,第三阶段为 34% (35 10 3) ;术后半年内良恶性病变受体的生存率无统计学差异 ,但恶性病变受体 1年生存率明显低于良性病变者 ,肝细胞性肝癌患者则多死于癌复发与转移 ;第三阶段良性病变病人 1年的生存率为 83 1% ,恶性疾病病人术后近期疗效较好 ,半年带癌生存率为 81% ;第三阶段无静脉转流技术的开展已显示其优越性 ;移植后血管并发症发生率逐渐下降 ,其发生率从2 9 %下降到 4 9% ,而胆管并发症仍是长期存活病人的主要问题。结论手术技术的完善与提高、术后并发症的及时合理诊治、受体的严格筛选以及原发疾病复发的防治是进一步提高我国肝脏移植疗效的努力方向。

ObjectiveTo sum up the clinical experience in recent 10 years in our organ transplantation center. Methods We retrospectively reviewed clinical data of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients′ clinical characteristics, surgical techniques, complications and survival rates were compared between the periods of 1993～1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000～2002 (phase Ⅲ). ResultsMalignant liver diseases were major indications for liver transplantation in phase Ⅰ (100%) and Ⅱ (53%), and phase Ⅲ (34%), respectively. The survival rate of recipients with benign liver diseases in phase Ⅲ significantly improved with the 3-month, 6-month and 1-year survival rates of 86%, 85% and 83.1%, respectively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87%, 81% and 46%, respectively. The recurrence of hepatitis B was 24% in 12 months after transplantation. The incidence of postransplantation vascular complications decreased significantly (from 29% in phase Ⅰ and Ⅱ to 4.9% in phase Ⅲ).Biliary complications remained one of the major problems for long-term survival. No veno-venous bypass was applied in phase Ⅲ. ConclusionStrict selection of candidate recipients, technical refinement, appropriate management of vascular and biliary complications, and prevention of recurrence of hepatitis B and malignant liver diseases are important for long-term survival.