摘要
目的总结再次肝移植的临床经验,以提高治疗效果。方法回顾性分析笔者所在医院2003年1月至2012年6月期间行再次肝移植的62例患者的临床资料,计算不同移植间隔时间患者的生存率,并比较围手术期死亡组和围手术期存活组患者的术前检查结果。结果 62例再次肝移植患者的1、2和5年累积生存率分别为67.7%、59.7%及56.4%,其中早期再次肝移植患者为38.5%、38.5%及30.8%,远期再次肝移植患者为75.5%、65.3%及63.3%。术后死亡28例,其中围手术期死亡20例(71.4%),感染是患者围手术期死亡的主要原因,占65.0%(13/20);余因多脏器衰竭死亡4例(20.0%);因肝动脉并发症死亡2例(10.0%);因门静脉并发症死亡1例(5.0%)。围手术期后死亡8例(28.6%),均因肿瘤复发而死亡。围手术期死亡组患者的终末期肝病模型(MELD)评分〔(26.95±9.28)分比(14.23±9.06)分〕、血肌酐(Cr)〔(157.3±88.0)μmol/L比(69.8±35.9)μmol/L〕、国际标准化比率(INR)〔1.676±0.744比1.124±0.286〕及总胆红素(TBiL)〔431.8μmol/L比248.2μmol/L〕均高于围手术期存活组(P<0.05);前者有12例(60.0%,12/20)患者的Cr值增高,后者有3例(7.1%,3/42)。生存的34例患者均获随访,随访时间3～104个月,平均49个月。随访期间,其生存状况均良好,肝功能正常,无肿瘤复发。结论再次肝移植是治疗移植肝功能衰竭的有效方法,选择合适的手术时机,制定合理的免疫抑制方案以降低围手术期感染率,均有利于提高再次肝移植患者的生存率。
Objective To summary the clinical experience of liver retransplantation（RLT）,and to improve the effect.Methods The clinical data of 62 cases who had received RLT in our institute from Jan.2003 to Jun.2012 were analyzed retrospectively.The survival rates of patients with different interval between two liver transplantation（LT） were calculated,and the data of patients who died and survived during perioperative period after operation were compared and analyzed.Results The 1-,2-,and 5-year cumulative survival rates of 62 patients were 67.7%,59.7%,and 56.4%,of early stage RLT patients were 38.5%,38.5%,and 30.8%,of later stage RLT patients were 75.5%,65.3%,and 63.3%,respectively.There were 28 patients died after operation,and 20 patients（71.4%） died during perioperative period,whose major cause of death were infection（65.0%,13/20）,in addition,4 cases（20.0%） died of multiple organ failure,2 cased（10.0%） died of hepatic artery complication,1 case（5.0%） died of portal vein complication.Eight cases（28.6%） died after perioperative period in reason of tumor recurrence.The model for end-stage liver disease（MELD） score（（26.95±9.28） score vs.（14.23±9.06） score）？,creatinine（Cr） level（（157.3±88.0） μmol/L vs.（69.8±35.9） μmol/L）？,international normalized ratio（INR） value（（1.676±0.744） vs.（1.124±0.286））？,and total bilirubin（TBiL） value（431.8 μmol/L vs.248.2 μmol/L） of patients died during perioperative period were higher than that of patients survived after perioperative period（P0.05）.The ratio of abnormal Cr of patients died during perioperative period and survived after perioperative period were 60.0%（12/20） and 7.1%（3/42）,respectively.The 34 patients who had survived after perioperative period were all got followed-up for 3-104 months（average 49 months）.There were no tumor recurrence during the followed-up,and liver function of them were normal.Conclusions RLT is an effective method for irreversible graft failure after LT.Optimum operative time and reasonable individual immunosuppressive regimen to decrease the infection rate are all contribute to the increase of the survival rate.
出处
《中国普外基础与临床杂志》
CAS
2013年第3期246-250,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝移植
再次手术
预后
Liver transplantation
Reoperation
Prognosis
