CAJ | 학술논문

目的总结再次肝移植的临床经验.方法回顾性分析本研究所1996年5月至2009年8月实施的28次再次肝移植病例资料,并结合文献进行讨论.结果在连续880例次同种异体原位肝移植中,有24例病人共接受28次再次肝移植术,再次移植率为3.18%.再次移植的指征分别为胆道并发症16例次(57.1%),原发病(肿瘤)复发6例次(21.4%),肝动脉血栓形成4例次(14.3%),慢性排斥反应(3.6%)和原发性移植肝无功能各1例次(3.6%).再次肝移植13例(17次手术)术后恢复顺利痊愈出院,随访至今已经存活51 d至67个月;11例于1～489 d病死.病死原因是:3例术后失血性休克,2例肝癌复发,2例心血管并发症,2例感染性休克,1例神经系统并发症,1例肝动脉血栓形成.病死率为39.3%.结论再次肝移植能有效挽救移植肝失功病人的生命,再移植指征的掌握、手术时机的选择、手术技巧的提高和围手术期的正确处理是提高再次移植成功率的关键.
목적 총결재차간이식적림상경험.방법 회고성분석본연구소1996년5월지2009년8월실시적28차재차간이식병례자료,병결합문헌진행토론.결과 재련속880례차동충이체원위간이식중,유24례병인공접수28차재차간이식술,재차이식솔위3.18%.재차이식적지정분별위담도병발증16례차(57.1%),원발병(종류)복발6례차(21.4%),간동맥혈전형성4례차(14.3%),만성배척반응(3.6%)화원발성이식간무공능각1례차(3.6%).재차간이식13례(17차수술)술후회복순리전유출원,수방지금이경존활51 d지67개월;11례우1～489 d병사.병사원인시:3례술후실혈성휴극,2례간암복발,2례심혈관병발증,2례감염성휴극,1례신경계통병발증,1례간동맥혈전형성.병사솔위39.3%.결론 재차간이식능유효만구이식간실공병인적생명,재이식지정적장악、수술시궤적선택、수술기교적제고화위수술기적정학처리시제고재차이식성공솔적관건.
Objective To summarize the clinical experience in liver retransplantation. Methods The clinical data of 24 patients receiving liver retransplantation 28 times in this hospital were retrospectively analyzed and discussed with relevant literature. Results Among the 880 consecutive liver transplantations, 28(3.18%) had liver retransplantation. The causes of liver retransplantation were biliary complications ( 16 cases, 57. 1%), carcinoma recurrece (6 cases, 21. 4%), hepatic artery thrombosis (4 cases, 14. 3%), chronic rejection (1 case, 3. 6%), primary nonfunction (1 case, 3.6%). Thirteen patients among the 24 were discharged healthy and were followed up for 51days to 67months. Eleven patients died. Three of them died of hemorrhagic shock, 2 of septic shock, 2 of hepatocellular carcinoma recurrence, 2 of cardiovascular system complication, 1of nervous system complication, and 1 of hepatic artery thrombosis. Conclusion Liver retransplantation can effectively save patients with graft failure. Proper indication, optimal operating time, improvement of operative skills,and appropriate treatment during the perioperative period are very important for promoting the rate of successful liver retransplantation.