中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2008年
3期
140-143
,共4页
沈英皓%樊嘉%周俭%吴志全%邱双健%黄晓武%孙健%王婷%史颖弘
瀋英皓%樊嘉%週儉%吳誌全%邱雙健%黃曉武%孫健%王婷%史穎弘
침영호%번가%주검%오지전%구쌍건%황효무%손건%왕정%사영홍
老年人%肝移植%治疗结果
老年人%肝移植%治療結果
노년인%간이식%치료결과
Aged%Liver transplantation%Treatment outcome
目的 探讨年龄≥60岁的老年患者肝移植的临床特点,总结临床诊治经验.方法 36例年龄≥60岁者接受肝移植治疗(老年组),术前其Child-Pugh评分为(7.86±2.06)分,其中34例采用非转流原位经典肝移植,2例为背驮式肝移植.术后采用他克莫司与糖皮质激素联用预防排斥反应,并辅以达利珠单抗诱导治疗.以同期施行肝移植、年龄小于60岁的214例患者作为对照.结果 老年组女性比例以及术前合并丙型肝炎、糖尿病的患者比例明显高于对照组,差异有统计学意义(P＜0.05,P＜0.05,P＜0.01),而合并乙型肝炎的患者比例则明显低于对照组(P＜0.01).两组在手术方式、供肝缺血时间以及术中情况等方面的差异均无统计学意义.老年患者术后气管插管时间为(9.0±12.1)h,明显长于对照组的(5.8±6.8)h(P＜0.05),36.1%的患者术后插管超过12 h,明显高于对照组的17.8%(P＜0.05).老年组术后心血管并发症和细菌感染的发生率分别为13.9%和77.8%,明显高于对照组的1.9%(P＜0.01)和59.3%(P＜0.05),而急性排斥反应发生率为5.6%,明显低于对照组的19.6%(P＜0.05).老年组患者术后1、2及3年存活率分别为77.8%、71.8 %和61.6 %,对照组分别为85.5 %、72.2 %和65.5 %,两组间各存活率的差异均无统计学意义;老年组中超出米兰标准者肝移植后的1、2及3年存活率分别为56.3%、56.3%和36.5%,对照组分别为78.0%、62.8%和62.8%,两组比较,各存活率的差异均有统计学意义(P<0.05).老年组患者的死亡原因,肺部感染占第一位(41.7%),明显高于对照组的14.9%(P＜0.05).结论 老年患者肝移植术后易并发感染和心血管疾病,肺部感染是老年患者术后死亡的主要原因;超出米兰标准的老年肝癌患者行肝移植需慎重.
目的 探討年齡≥60歲的老年患者肝移植的臨床特點,總結臨床診治經驗.方法 36例年齡≥60歲者接受肝移植治療(老年組),術前其Child-Pugh評分為(7.86±2.06)分,其中34例採用非轉流原位經典肝移植,2例為揹馱式肝移植.術後採用他剋莫司與糖皮質激素聯用預防排斥反應,併輔以達利珠單抗誘導治療.以同期施行肝移植、年齡小于60歲的214例患者作為對照.結果 老年組女性比例以及術前閤併丙型肝炎、糖尿病的患者比例明顯高于對照組,差異有統計學意義(P＜0.05,P＜0.05,P＜0.01),而閤併乙型肝炎的患者比例則明顯低于對照組(P＜0.01).兩組在手術方式、供肝缺血時間以及術中情況等方麵的差異均無統計學意義.老年患者術後氣管插管時間為(9.0±12.1)h,明顯長于對照組的(5.8±6.8)h(P＜0.05),36.1%的患者術後插管超過12 h,明顯高于對照組的17.8%(P＜0.05).老年組術後心血管併髮癥和細菌感染的髮生率分彆為13.9%和77.8%,明顯高于對照組的1.9%(P＜0.01)和59.3%(P＜0.05),而急性排斥反應髮生率為5.6%,明顯低于對照組的19.6%(P＜0.05).老年組患者術後1、2及3年存活率分彆為77.8%、71.8 %和61.6 %,對照組分彆為85.5 %、72.2 %和65.5 %,兩組間各存活率的差異均無統計學意義;老年組中超齣米蘭標準者肝移植後的1、2及3年存活率分彆為56.3%、56.3%和36.5%,對照組分彆為78.0%、62.8%和62.8%,兩組比較,各存活率的差異均有統計學意義(P<0.05).老年組患者的死亡原因,肺部感染佔第一位(41.7%),明顯高于對照組的14.9%(P＜0.05).結論 老年患者肝移植術後易併髮感染和心血管疾病,肺部感染是老年患者術後死亡的主要原因;超齣米蘭標準的老年肝癌患者行肝移植需慎重.
목적 탐토년령≥60세적노년환자간이식적림상특점,총결림상진치경험.방법 36례년령≥60세자접수간이식치료(노년조),술전기Child-Pugh평분위(7.86±2.06)분,기중34례채용비전류원위경전간이식,2례위배타식간이식.술후채용타극막사여당피질격소련용예방배척반응,병보이체리주단항유도치료.이동기시행간이식、년령소우60세적214례환자작위대조.결과 노년조녀성비례이급술전합병병형간염、당뇨병적환자비례명현고우대조조,차이유통계학의의(P＜0.05,P＜0.05,P＜0.01),이합병을형간염적환자비례칙명현저우대조조(P＜0.01).량조재수술방식、공간결혈시간이급술중정황등방면적차이균무통계학의의.노년환자술후기관삽관시간위(9.0±12.1)h,명현장우대조조적(5.8±6.8)h(P＜0.05),36.1%적환자술후삽관초과12 h,명현고우대조조적17.8%(P＜0.05).노년조술후심혈관병발증화세균감염적발생솔분별위13.9%화77.8%,명현고우대조조적1.9%(P＜0.01)화59.3%(P＜0.05),이급성배척반응발생솔위5.6%,명현저우대조조적19.6%(P＜0.05).노년조환자술후1、2급3년존활솔분별위77.8%、71.8 %화61.6 %,대조조분별위85.5 %、72.2 %화65.5 %,량조간각존활솔적차이균무통계학의의;노년조중초출미란표준자간이식후적1、2급3년존활솔분별위56.3%、56.3%화36.5%,대조조분별위78.0%、62.8%화62.8%,량조비교,각존활솔적차이균유통계학의의(P<0.05).노년조환자적사망원인,폐부감염점제일위(41.7%),명현고우대조조적14.9%(P＜0.05).결론 노년환자간이식술후역병발감염화심혈관질병,폐부감염시노년환자술후사망적주요원인;초출미란표준적노년간암환자행간이식수신중.
Objective To investigate the features and treatment outcome of liver transplantation in patients over 60 years old.Methods From April 2001 to August 2005,36 patients over 60 years old(senile group)and 214 patients under 60 years of age(control group)received liver transplantation in our liver transplantation unit.The Child-Pugh Score of the senile group was 7.86±2.06.Thirtyfour aged patients received standard orthotopic liver transplantation without bypass and the other two aged patients received piggyback liver transplantion.Postoperative immunosuppression was based on the combination of tacrolimus,hormone and daclizumab.The differences between the senile group and control group in preoperative,intraoperative and postoperative variables,including main clinical and laboratory features.were analyzed.Results The proportion of female and morbidity of hepatitis C and diabetes were higher in older liver transplant recipients(P＜0.05,P＜0.05,P＜0.01),while the morbidity of hepatitis B was lower than in control group(P＜0.01).There were no significant differences between two groups in the surgical techniques,ischemia duration of donor liver,or other intra operative data(P＞0.05).The time of postoperative incubation in senile group was about(9.0±12.1)h,longer than in control group,which was about(5.8±6.8)h(P＜0.05).Intubation duration over 12 h occurred in 36.1%(13/36)of senile group and 17.8 %(38/214)of control group respectively(P＜0.05).The postoperative incidence of cardiovascular disease and infection was about 13.9 % and 77.8 % in senile group,while about 1.9%(P＜0.01)and 59.3%(P＜0.05)in control group,respectively.However,the incidence of acute rejection in senile group was 5.6%,lower than 19.6 % in control group(P＜0.05).The 1-,2- and 3- year actuarial survival rate was 77.8%,71.8 % and 61.6 % in senile group,and 85.5 %,72.2 % and 65.5 % in control group,respectively (P＞0.05).In cases of liver carcinoma exceeding Milan criteria survival rate was markedly lower in senilc group than in control group(1-,2- and 3-year survival rate of 56.3 %,56.3 % and 36.5 % in senile group and 78.0 %,62.8 % and 62.8 % in control group respectively,P＜0.05).The pulmonarv infection was the most important cause of death in senile patients accounting for 41.7% and marklv higher than 14.9 % of control group(P<0.05).Conclusion The postoperative incidence of cardiovascular disease and infection of senile group was higher and pulmonary infection was the most common cause of mortality in elderly liver recipients.Liver transplantation for the older patients with hepatoeellular carcinoma over Milan criteria should be prudent.
