摘要
目的总结两个阶段开展临床肝移植的经验和体会。方法分析8例人体原位肝移植,包括1例肝肾联合移植的治疗结果。供肝保存第一阶段采用门静脉及肝动脉离体灌注,第二阶段采用腹主动脉及肠系膜上静脉UW液快速原位灌注。受体手术采用原位肝脏植入,吻合次序为肝上下腔静脉、门静脉、肝下下腔静脉、肝动脉和胆管,完成门静脉吻合后即开放门静脉结束无肝期。两个阶段均使用了免疫抑制剂但方法不同。结果第一阶段移植生存期最短39天,最长203天。除1例死于肿瘤复发外,全部死于败血症及严重感染。第二阶段移植病人1例半年后死于肿瘤转移,另3例仍健存,其中肝肾联合移植者生存已超过3年,在社会上正常生活工作。结论第二阶段取得了较好的效果。其中合理选择适应症,良好的供肝保存以及免疫抑制剂的使用等对肝移植的成功有重要影响。
Objective To summarize our experience of Carrying on clinical orthotopic liver transplantation in two stages of early 1980s and late 1990s. Methods The clinical data of 8 cases of liver transplantations including 1 case of combined liver kidney transplantation were analyzed retrospectively.The donor liver was preserved with isolated irrigation of portal vein (PV) and hepatic artery (HA) in the first stage and a rapid in situ irrigation from abdominal aorta(AA)and superior mesenteric vein(SMV) with UW solution in the second stage. The orthotopic liver transplantation was used in the recipient operation. The anastomotic seqecence was as follow:Supra hepatic inferior vena cava(SIVC),PV,sub hepatic IVC,HA and biliary duct.After the portal vein anastomosis was finished and it was opened at once,the ahepatic stage was ended.Immunosuppressant was used in the two stages with different methods.In the first stage,the longest living time was 203 days,and the shortest was 39 days.The cause of death was severe infection and septicemia except for one case died from carcinoma recurrence.In the second stage,3 cases were sill alive until now and only one case died from carcinoma recurrence half a year later.Among them,the patient who received combined liver kidney transplantation had survived over three years and recovered normal life and work in the society. Conclusion Clinical liver transplantation has get a great progress in the second stage.A more reasonable seletion of operation indications,well preserved donor organ and correct usage of immunosappressant are very important for the success of liver transplantation.
出处
《岭南现代临床外科》
2003年第3期164-166,共3页
Lingnan Modern Clinics in Surgery
关键词
肝移植
肝肾联合移植
Liver transplantation
Combined liver kidney transplantation
