人体原位肝移植三例报告

Orthotopic liver transplantation:three cases report

目的报告 3例肝移植的治疗经验 ,探讨肝移植的手术技术与疗效。方法 2例原发性肝癌合并门静脉高压病人、1例终末期胆道病合并胆汁性肝硬化病人均施行同种异体原位肝移植术。供肝采用UW液原位灌注 ,快速切取。肝移植方式采用背驮式原位肝移植术。 2例肝癌病人术前 1周开始服用抗乙肝病毒药物拉米呋啶 ,并进行一个疗程化疗 ;术后免疫抑制治疗采用环孢素A、激素和 /或晓悉联合应用。术后分别在 30d、6 0d、90d按 5 FuAB(5 Fu +阿霉素 +顺铂 )方案进行化疗。例3病人术前积极予肝肾功能维护及人工肝支持。结果例 1肝移植术中供肝立即发挥功能 ,病人术毕随即清醒。术后第 9d发生轻度急性排斥反应 ,用甲基强的松龙冲击后控制。追踪随访 9个月生活质量良好 ;例 2肝移植术中供肝立即发挥功能 ,病人在术后 1h内清醒。术后第 11d发生轻度急性排斥反应 ,用甲基强的松龙冲击后控制。随访至今患者生活学习行如常人 ,生活质量良好 ;例 3肝移植术中供肝立即发挥功能 ,术后死于急性肾功能衰竭。结论 (1)精细的手术操作和完善的麻醉配合是确保手术成功的关键 ;(2 )手术后的严密观察、正确及时处理并发症以及围手术期良好的综合支持治疗是确保患者术后能否长期存活的重要条件 ;(3)

Objective To investigate the clinical experiences,surgical technique and therapeutic effects of orthotopic liver transplantation (OLT).Methods OLT was performed on two patients with liver cirrhosis of hepatitis B complicated with hepatocellular carcinoma and one patient with end-stage biliary tract disease.Infusion in situ of the donors livers were carried out by UW solution and harvested.Liver transplantation was carried out by using pggyback method.Lamividine was used on 7th day preoperation in two cases and artificial liver support system was applied in one case.Immunosuppressive drugs consisted of cyclosporine A,corticosteroid and/or cellcept.Chemotherapeutic drugs that are 5-Fu,adriamycin and cisplatin were used on day 30,day 60 and day 90 postoperation respectively.Results Three transplant livers had rapidly normal functions postoperation.Two patients suffered from acute mild liver rejection on day 9 and day 11 postoperation respectively but passed at over the end by using methylprednisolone that have been survived for 9 and 5 months respectively with normal life quality,one died due to postoperative acute renal function failure.Conclusion The fine surgical skill and perfect anesthesia are important projections in OLT,the effective management of postoperative complications and proper nutritional support play an important role during perioperative period on survival of the patients after OLT.OLT is the best effective treatment for the patients with large hepatocellular carcinoma with liver function failure without distant metastasis at present.