【摘要】 目的:总结肝移植患者预后的影响因素,探讨进一步提高肝移植疗效的措施。方法:回顾性分析565例原位肝移植患者资料,统计患者生存率及并发症发生率。结果:565例肝移植患者的随访时间为3～104个月。2000年5月至2003年12月完成的171例患者术后1个月、1年、3年、5年的存活率分别为87.8%、73.2%、60.2%、57.7%;2004年1月至2009年1月完成的394例患者术后1个月、1年、3年、5年的存活率分别为91.2%、84.9%、69.2%、66.1%,存活率显著提高;良性肝病患者术后1年、3年、5年的存活率分别为83.3%、79.8%、78.5%;肝癌患者术后1年、3年、5年的存活率分别为78.4%、49.1%、45.1%。肝移植术后早期因腹腔内出血接受二次手术、血管性并发症、严重感染、急性肾功能衰竭、移植物原发无功能的发生率分别为1.1%、1.6%、13.6%、7.4%、1.2%。术后的远期并发症主要有:肝癌复发、胆道并发症、乙肝复发、新发恶性肿瘤、移植物慢性失功能、慢性肾功能损伤等,发生率分别为40.3%、6.7%、2.1%、0.9%、0.9%、1.1%;其中,符合和超出米兰标准的肝癌患者的肝癌复发率分别为8.1%和62.5%,所有肝癌复发患者的中位生存时间为19.6个月。结论:肝移植是治疗各种终末期肝病的有效措施,在供肝短缺的情况下,应优先将供肝分配给良性肝病患者和符合米兰标准的肝癌患者。更多还原

【Abstract】 Objective:To determine the preventative and curative strategies after liver transplantation by investigating the risk factors on prognosis.Methods: The data of 565 consecutive patients who underwent orthotopic liver transplantation were retrospectively analyzed with the survival rate and complication morbidity.Results: The follow-up time ranges from 3 to 104 months of all the 565 patients after liver transplantation.From January 2004 to January 2009,the patient survival rates were 91.2% after 1 month,84.9% after 1 year,69.2% after 3 years,and 66.1% after 5 years,while they were 87.8%,73.2%,60.2%,and 57.7% from May 2000 to December 2003.The patient survival rates were 83.3% after 1 year,79.8% after 3 years,and 78.5% after 5 years in non-hepatocellular carcimoma(non-HCC) group,while they were 78.4%,49.1%,and 45.1% in HCC group.In early stage after surgery,the morbidities of re-operation due to intra-abdominal hemorrage,vascular complication,severe infection,acute renal failure and primary graft dysfunction were 1.1%,1.6%,13.6%,7.4%,and 1.2%,while in late stage,the morbidities of HCC recurrence,biliary complications,HBV recurrence,de novo malignancy,chronic graft dysfunction were 40.3%,6.7%,2.1%,0.9%,0.9%,and 1.1%,respectively.The HCC recurrent rates were 8.1% versus 62.5% in matching Milan criteria group or exceeding Milan criteria group and the median survival time was 19.6 months of all recurrent patients.Conclusion: Liver transplantation has been the effective treatment for end stage liver disease.Due to the shortage of graft,we prefer to do operations for the patients without HCC or the patients with HCC but matching Milan Criteria.更多还原