【摘要】 目的:探讨慢性重型肝炎行肝移植术的合适手术时机。方法:总结2003年9月～2005年7月我科收治的59例慢性重型肝炎病人的临床资料,有52例行肝移植术,7例未行肝移植术,并就病人肝移植手术时机的选择和预后作回顾性分析。结果:本组59例慢性重型肝炎病人,肝移植组的1年存活率为83.3%,明显高于内科综合治疗组的14.3%(P<0.01)。肝移植组中,术前终末期肝病模型(MELD)评分≥16分病人的1年生存率为76.5%,明显低于MELD评分<16分病人的89.5%(P<0.05);术前MELD评分≥16分的病人平均手术时间(7.3±2.6)h,明显长于MELD评分<16分的(5.4±1.5)h(P<0.05);术前MELD评分≥16分病人的术中失血量和输血量分别为(4860±1980)ml和(5240±2160)ml,明显多于MELD评分<16分病人的(1780±670)ml和(2110±790)ml(P<0.01);术前MELD评分≥16分病人的术后呼吸支持时间I、CU留置时间和住院时间分别为(5.3±2.2)d(、6.1±2.7)d和(31.7±11.6)d,明显长于MELD评分<16分病人的(3.2±2.1)d(、3.4±2.0)d和(23.8±7.5)d(P<0.05);术前MELD评分≥16分病人的平均住院费用为(36.9±9.3)万元,明显高于MELD评分<16分病人的(23.2±5.2)万元(P<0.05);术前MELD评分≥16分病人的术后各种感染及肾功能衰竭并发症的发生率分别为71.4%和23.8%,明显高于MELD评分<16分病人的35.4%和3.2%(P<0.01)。结论:慢性重型肝炎病人术前MELD评分≥12分并<16分时是比较合适的手术时机,而术前MELD评分≥16分的病人手术预后明显较差。更多还原

【Abstract】 Objective To explore the optimal time of liver transplantation for chronic severe hepatitis.Methods The clinical data of 59 cases of chronic severe hepatitis admitted from September 2003 to July 2005 were analysed.Among these 59 patients,52 underwent liver transplantation(group 1),and the other 7 did not(group 2).The timing and prognosis of liver transplantation were studied.Results One-year survival rate in group 1 and group 2 was 83.3% and 14.3%,respectively(P<0.01).If the patients in group 1 were further divided into two subgroups according to the score of model for end-stage liver disease(MELD) the mean operation time,one-year survival rate,blood loss during the operation,quantity of blood transfusion,respiratory support time after the operation,intensive care unit hospitalization time,total hospitalization duration,mean cost,infective morbidity,as well as the incidence of renal failure were(7.3±2.6) h,76.5%,(4 860±1980) ml,(5 240±2160) ml,(5.3±2.2) d,(6.1±2.7) d,(31.7±11.6) d,(369±93) thousand RMB,71.4%,and 23.8% in patients with MELD score≥16,while they were(5.4±1.5) hours,89.5%,(1780±670) ml,(2110±790) ml,(3.2±2.1) d,(3.4±2.0) d,(23.8±7.5) d,(232±52) thousand RMB,35.4% and 3.2% respectively in patients with MELD score<16.Conclusions The chronic severe hepatitis patients with a MELD score higher than 12 or lower than 16 are suitable candidates for liver transplantation.The prognosis would be poor if the MELD score exceeds 16.更多还原