CAJ | 학술논문

目的探讨肝移植治疗终末期肝泡型包虫病的临床应用价值.方法回顾性分析2000年12月至2010年8月新疆医科大学第一附属医院收治的8例行肝移植治疗终末期肝泡型包虫病患者的临床资料,观察患者手术时间、无肝期、术中红细胞悬液输注量、术后并发症等指标.结果 8例患者中位手术时间为635 min(490～760 min),中位无肝期为66 min(44～240 min),术中红细胞悬液输注量中位数为20U(4～40 U).1例行抢救性经典原位肝移植的患者因严重的肝性脑病、肾功能衰竭和凝血功能障碍于术后1 d死亡,其余7例患者手术成功.术后中位随访时间6个月(3～29个月).3例患者分别于术后3、5、6个月因胆源性脓毒血症、胆道铸型、急性排斥反应等并发症死亡.1例患者术后发生胆管吻合口狭窄,行胆肠吻合后痊愈;1例患者左肺转移灶明显缩小和稳定;1例患者术后发生胆管吻合口漏经治疗后痊愈;1例行左半健侧肝脏自体移植的患者,健康生存.结论终末期肝泡型包虫病是肝移植的适应证.低剂量免疫抑制剂和术后长期服用抗包虫药物是预防术后肝泡型包虫病复发和转移的关键.自体肝移植术后因无需免疫抑制剂治疗,是治疗终末期肝泡型包虫病的理想术式.
목적 탐토간이식치료종말기간포형포충병적림상응용개치.방법 회고성분석2000년12월지2010년8월신강의과대학제일부속의원수치적8례행간이식치료종말기간포형포충병환자적림상자료,관찰환자수술시간、무간기、술중홍세포현액수주량、술후병발증등지표.결과 8례환자중위수술시간위635 min(490～760 min),중위무간기위66 min(44～240 min),술중홍세포현액수주량중위수위20U(4～40 U).1례행창구성경전원위간이식적환자인엄중적간성뇌병、신공능쇠갈화응혈공능장애우술후1 d사망,기여7례환자수술성공.술후중위수방시간6개월(3～29개월).3례환자분별우술후3、5、6개월인담원성농독혈증、담도주형、급성배척반응등병발증사망.1례환자술후발생담관문합구협착,행담장문합후전유;1례환자좌폐전이조명현축소화은정;1례환자술후발생담관문합구루경치료후전유;1례행좌반건측간장자체이식적환자,건강생존.결론 종말기간포형포충병시간이식적괄응증.저제량면역억제제화술후장기복용항포충약물시예방술후간포형포충병복발화전이적관건.자체간이식술후인무수면역억제제치료,시치료종말기간포형포충병적이상술식.
Objectiye To investigate the value of liver transplantation for the treatment of end-stage hepatic alveolar echinococcosis(HAE).Methods The clinical data of 8 patients with end-stage HAE who received liver transplantation at the First Affiliated Hospital of Xinjiang Medical University from December 2000 to August 2010 were retrospectively analyzed.The operation time,anhepatic phase,infusion of suspension of red blood cells and postoperative complications were observed.Results The median operation time,anhepatic phase and infusion of suspension of red blood cells were 635 minutes(range,490-760 minutes),66 minutes(range,44-240 minutes)and 20 U(range,4-40 U).Liver transplantation was successfully carried out on 7 patients except for 1 patient who received emergent liver transplantation died of severe hepatic encephalopathy,renal failure and coagulation disorder on postoperative day 1.The median follow-up time was 6 months(range,3-29 months).One patient died of septicopyemia in postoperative month 3,1 died of incurable infection of bile duct in postoperative month 5,and 1 died of acute rejection in postoperative month 6.One patient was complicated with stricture of the bile duct anastomosis,and was cured by choledochojejunostomy.The size of the metastatic lesion in the left lung of 1 patient was reduced.One patient who underwent liver autotransplantation had no signs of residual liver disease with good liver function.Conclusion End-stage HAE is an indication for liver transplantation.A minimum dose of immunosuppressive agent and systemic administration of anti-HAE drugs are necessary to prevent the recurrence of HAE and ensure a long-term survival.Liver autotransplantation is the optimal method for the treatment of end-stage HAE,because no immunosuppressive agent is needed after operation.