CAJ | 학술논문

背景：急性肝衰竭行急诊肝移植患者围手术期治疗的病情复杂，风险大，并发症多，死亡率高，与普通肝脏移植有着明显不同。目的：总结急诊肝移植治疗急性肝功能衰竭的围手术期治疗经验，以提高急性肝功能衰竭的治疗成功率。方法：回顾性分析38例因急性肝功能衰竭行急诊肝移植患者的临床资料，男21例，女17例，年龄15-69岁。其中乙型肝炎病毒性肝炎23例(其中乙型合并丁型肝炎2例)，Wilsons病7例，3例为毒蕈中毒，2例不明原因药物肝脏损害，1例雷公藤多甙中毒，1例为外伤行肝脏部分切除后失代偿，1例尸体肝移植后患者。结果与结论：38例患者生存时间为13-1740 d，中位生存时间为634 d。患者的围手术期存活率为76%，1年存活率为63%，2年存活率为58%。9例围手术期死亡原因包括脑水肿及颅内高压、肾功能衰竭、严重肺部感染、多脏器功能衰竭、凝血功能障碍(颅内出血、上消化道出血等)、急性成人呼吸窘迫综合征、移植物原发性无功能。目前急诊肝移植仍是治疗急性肝功能衰竭最有效的方法，出血、感染、排异反应是死亡的主要原因，肝移植围手术期间每一环节的处理，对于肝移植的成功和患者长期存活具有重要意义。
배경：급성간쇠갈행급진간이식환자위수술기치료적병정복잡，풍험대，병발증다，사망솔고，여보통간장이식유착명현불동。목적：총결급진간이식치료급성간공능쇠갈적위수술기치료경험，이제고급성간공능쇠갈적치료성공솔。방법：회고성분석38례인급성간공능쇠갈행급진간이식환자적림상자료，남21례，녀17례，년령15-69세。기중을형간염병독성간염23례(기중을형합병정형간염2례)，Wilsons병7례，3례위독심중독，2례불명원인약물간장손해，1례뢰공등다대중독，1례위외상행간장부분절제후실대상，1례시체간이식후환자。결과여결론：38례환자생존시간위13-1740 d，중위생존시간위634 d。환자적위수술기존활솔위76%，1년존활솔위63%，2년존활솔위58%。9례위수술기사망원인포괄뇌수종급로내고압、신공능쇠갈、엄중폐부감염、다장기공능쇠갈、응혈공능장애(로내출혈、상소화도출혈등)、급성성인호흡군박종합정、이식물원발성무공능。목전급진간이식잉시치료급성간공능쇠갈최유효적방법，출혈、감염、배이반응시사망적주요원인，간이식위수술기간매일배절적처리，대우간이식적성공화환자장기존활구유중요의의。
BACKGROUND:Perioperative treatment of emergency liver transplantation for acute hepatic failure is extremely different from common liver transplantation, due to complex conditions, high risk, several complications, and high mortality. OBJECTIVE:To summarize the experience of emergency liver transplantation for acute hepatic failure during the perioperative period, and to increase the success rate in treatment of acute hepatic failure. METHODS:A retrospective analysis was undertaken on the clinical data of 38 cases undergone emergency liver transplantation for acute hepatic failure. There were 21 male and 17 female, who aged 15-69 years. Among them, 23 cases had hepatitis B virus (including 2 cases with hepatitis B and C virus), 7 cases had Wilsons disease, 3 cases had mushroom poisoning, 2 cases had unknown liver damage, 1 case had Tripterygium wilfordi poisoning, 1 case had decompensation after partial liver resection due to trauma, and 1 case had liver transplantation from corpse. RESULTS AND CONCLUSION:The survival time of the involve patients was 13-1 740 days, and the median survival time was 634 days. Perioperative survival rate was 76%, 1-year survival rate was 63%, and 2-year survival rate was 58%. During the perioperation nine cases died of brain edema and intracranial hypertension, renal failure, severe pulmonary infection, multiple organ failure, coagulation disorders (intracranial hemorrhage, upper digestive tract hemorrhage), acute respiratory distress syndrome and primary graft non-function. At present, emergency liver transplantation is stil the most effective way for acute liver failure. Hemorrhage, infection and rejection are the leading causes of the death. Each perioperative treatment is of great significance for the success of liver transplantation and long-term survival.