高龄患者的同种异体原位肝脏移植

Orthotopic liver transplantation in the elderly patients

目的 探讨老年患者肝移植手术的特点 ,以期扩大肝移植的适应证。方法 对 2 0 0 0年 8月～ 2 0 0 2年 1月我院进行的 3 6例同种异体原位肝移植患者的临床资料进行回顾性分析 ,并比较其中 5例 60岁以上者 (≥ 60岁组 ,老年组 )与其他 3 1例年龄在 60岁以下的患者 ( <60岁组 )手术后恢复情况 ;分析老年患者的手术时间、手术中出血、手术后并发症、住院时间、手术后ICU停留时间等情况。结果 老年组患者手术时间、手术后出血及手术后恢复时间与 <60组无明显差别 ,手术后停留ICU的时间稍长 ,急性排异的发生率 ( 0 / 5 )低于 <60组 ( 8/ 3 1) (P <0 .0 5 )。老年组中 1例围手术期死于急性肾衰竭 ,其他 4例顺利恢复出院 ,其中 3例已分别生存 7,9,2 2个月。结论 对于无严重心、肺、肾功能障碍的终末期肝病的老年患者 ,可作为肝移植的适应证。

Objective To assess the outcome of liver transplantation in patients over sixty years of age,in order to attempt to expand the indications of liver transplantation. Methods From August,2000 to January,2002, the clinical data of 36 patients who underwent liver transplantation in our department were analysed retrospectively. Of the 36 cases, the data (operating time, the length of hospitalization, rejection rate and ICU stay days after operation) of 5 patients whose age were ≥60 years (elderly group) and the data of 31 patients whose age were under 60 years ( < 60 years group) were compared. Results The length of hospitalization was the same in both groups, and there were no significant differences in the operation time, ICU staying and blood losing during operation between the two groups. The rejection rate in the elderly group was significantly lower than that in < 60 years group (P< 0.05). Only 1 case in the elderly group died of acute renal failure, the other 4 recovered smoothly. Of the 4 patients,3alived for 7,9, 22 months, respectively. Conclusions For the elderly patients with end-stage liver disease,if they have good heart, lung and renal function, liver transplantation could be considered.