【作者】 卢实春； 王孟龙； 夏仁品； 武聚山； 陈永兵； 黄春； 段钟平； 朱岳；

【Author】 LU Shi-chun WANG Meng-long XIA Ren-ping WU Ju-shan CHEN Yong-bing HUANG Chun DUAN Zhong-ping ZHU Yue Liver Transplantation Center of Beijing You-an hospital affiliated with Capital University of Medical Science (Beijing 100054)

【机构】 首都医科大学附属北京佑安医院肝脏移植中心；

【摘要】 目的:总结慢性重症乙型肝炎肝移植治疗的临床经验。方法:回顾分析了50例慢性重症乙型肝炎肝移植的临床资料及随访结果。结果:50例患者中术前肝功能状态全为 Child C 级;MELD 指数平均为30;术前不同程度肝性脑病者占44%(22/50);术前腹腔感染占30%(15/50);术前肝肾综合征占40% (20/50);术前行人工肝支持治疗25例共35例次:术前消化道出血8例,占16%;术前乙肝病毒活跃复制状态30例,占60%。全组围手术期死亡(术后30天内死手亡)6人,占12%,主要术后并发症按顺序排列如下:肺部感染25例占50%;多器官功能衰竭(MOF)10例,占20%,无原发性肝无功能,无血管系统并发症。围手术期(30天以内)生存率88%,一年生存率80%。用拉米呋啶加乙肝高价免疫球蛋白预防乙肝复发, 平均随访12个月无一例乙肝复发。结论:慢性重症肝炎肝移植受体术前肝功能状态极差,多伴有全身各器官系统功能损害及内环境失调,术前应尽可能争取时间改善内环境和各器官系统功能,包括针对性地使用人工肝支持技术,术中注意凝血功能改善及尿量的维持,缩短手术时间;术后加强对肝、肺、肾功能的强化支持治疗,合理使用免疫抑制剂:有效预防和治疗肺部感染及二重感染。注意上述各个环节,慢性重症乙型肝炎肝移植治疗可获得满意的临床效果。更多还原

【Abstract】 Objective:To summarize the experience of Liver transplantation for acute on chronic hepatic failure patients caused by Hepatitis B.Methods:The clinical and follow-up data of 50 cases from 2004 to 2005 were analyzed retrospectively.Results:All the 50 patients had Child C hepatic function,and their mean MELD score is 30.Before receiving Liver transplantation(Ltx),they suffered from several complications including hepatic encephalopathy 44%(22/50),abdominal infection30%( 15/50),hepatorenal syndrome 40%(20/23),as well as alimentary tract hemorrhage 16%(8/50).25 patients totally underwent artificial liver support system therapy35 times.HBV active replication(HBV DNA positive)occurred in 60% of the patients(30/50).6 patients died within 30 days after Ltx,and the mortality rate is12%.Leading post-Ltx complications were pneumonia 50%(25/50),multiple-organ failure(MOF)20%(10/50).There were no primary liver dysfunction and blood vessel complications in all the patients.One-year survival rate is 80%.Lamivudine combined HBIG were used to prevent HBV recurrence,and there was not any recurrent patient during a mean 12-month follow up period. Conclusion:chronic hepatitis B patients waiting for Ltx are generally with severely damaged liver function, multiple-organ impairment and inner environment disturbance.Therefore much should be done to improve organ function so that better inner environment can be obtained before Ltx.During operation,attention should be paid in the maintenance of coagulability and urine output and in the shrinking of operation time.Attention should also be paid to the intensive care of liver,lung and kidney functions,the appropriate use of immunity depressants and the effective prophylaxis for pneumonia and secondary infections post-operatively.With sufficient efforts in all the aspects listed above,chronic hepatitis B patients underwent Ltx could expect a satisfactory clinical outcome and a good quality of life.更多还原