中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2013年
2期
105-107
,共3页
叶啟发%明英姿%赵杰%彭贵主%张毅
葉啟髮%明英姿%趙傑%彭貴主%張毅
협계발%명영자%조걸%팽귀주%장의
肝移植%脂肪变性供肝
肝移植%脂肪變性供肝
간이식%지방변성공간
Liver transplantation%Steatosis liver donor
目的 探讨脂肪肝临床肝移植的疗效,为边缘供肝的使用提供科学依据.方法 自2002年至2011年407例供肝中筛选出80例脂肪肝.其中男性69例,女性11例.年龄20～54岁不等.80例中有16例重度脂肪变性(≥60％)供肝因合并严重灌注性损伤而予剔除,其余64例脂肪变性供肝(steatosis liver donor,SLD)按脂肪肝严重程度分为轻S1组(＜30％,n=22)、中S2组(30％～50％,n＝25)、重S3组(≥60％,n=17).随机抽取无脂肪肝80例作为S0对照组.结果 S0组、S1组、S2组、S3组移植物早期肝功能延迟恢复发生率分别为5％、9.1％、20％ 、29.41％.S3组2例发生原发性无功能(PNF)占11.76％(2/17),占SLD移植后PNF发生率的3.12％(2/64).结论 SLD移植后移植物早期肝功能延迟恢复的发生率以及近期并发症发生率虽较无脂肪变性者高,但不影响移植后疗效.S1～S3组移植术后1年内死亡率与SLD无相关性.重视SLD移植后并发症的处理,特别是加强术中、术后缺血再灌注损伤的防治,改善微循环,加强护肝治疗,减少近期免疫制剂用量,可取得与正常供肝同样移植疗效.
目的 探討脂肪肝臨床肝移植的療效,為邊緣供肝的使用提供科學依據.方法 自2002年至2011年407例供肝中篩選齣80例脂肪肝.其中男性69例,女性11例.年齡20～54歲不等.80例中有16例重度脂肪變性(≥60％)供肝因閤併嚴重灌註性損傷而予剔除,其餘64例脂肪變性供肝(steatosis liver donor,SLD)按脂肪肝嚴重程度分為輕S1組(＜30％,n=22)、中S2組(30％～50％,n＝25)、重S3組(≥60％,n=17).隨機抽取無脂肪肝80例作為S0對照組.結果 S0組、S1組、S2組、S3組移植物早期肝功能延遲恢複髮生率分彆為5％、9.1％、20％ 、29.41％.S3組2例髮生原髮性無功能(PNF)佔11.76％(2/17),佔SLD移植後PNF髮生率的3.12％(2/64).結論 SLD移植後移植物早期肝功能延遲恢複的髮生率以及近期併髮癥髮生率雖較無脂肪變性者高,但不影響移植後療效.S1～S3組移植術後1年內死亡率與SLD無相關性.重視SLD移植後併髮癥的處理,特彆是加彊術中、術後缺血再灌註損傷的防治,改善微循環,加彊護肝治療,減少近期免疫製劑用量,可取得與正常供肝同樣移植療效.
목적 탐토지방간림상간이식적료효,위변연공간적사용제공과학의거.방법 자2002년지2011년407례공간중사선출80례지방간.기중남성69례,녀성11례.년령20～54세불등.80례중유16례중도지방변성(≥60％)공간인합병엄중관주성손상이여척제,기여64례지방변성공간(steatosis liver donor,SLD)안지방간엄중정도분위경S1조(＜30％,n=22)、중S2조(30％～50％,n＝25)、중S3조(≥60％,n=17).수궤추취무지방간80례작위S0대조조.결과 S0조、S1조、S2조、S3조이식물조기간공능연지회복발생솔분별위5％、9.1％、20％ 、29.41％.S3조2례발생원발성무공능(PNF)점11.76％(2/17),점SLD이식후PNF발생솔적3.12％(2/64).결론 SLD이식후이식물조기간공능연지회복적발생솔이급근기병발증발생솔수교무지방변성자고,단불영향이식후료효.S1～S3조이식술후1년내사망솔여SLD무상관성.중시SLD이식후병발증적처리,특별시가강술중、술후결혈재관주손상적방치,개선미순배,가강호간치료,감소근기면역제제용량,가취득여정상공간동양이식료효.
Objectives To investigate the results of liver transplantation using steatosis liver donors in order to provide a scientific basis for the use of marginal donors.Methods From 2002 to 2011,80 of 407 were steatosis liver donors.There were 69 males and 11 females.Their age ranged from 20-54 years old.Sixteen donor livers with severe fatty liver and reperfusion injury were not used.The remaining 64 livers were divided into a S1 group (mild steatosis,n=22),a S2 group (moderate steatosis,n=25),and a S3 group (severe steatosis,n=17).A S0 group was used as a control (randomly selected fat-free liver,n=80).Results The occurrence rates of delayed graft function (DGF) in the S0,S1,S2,S3 groups were 5％,9.1％,20％,29.41％,respectively.Primary nonfunctioning occurred in 2 cases of the S3 group,which represented a 11.76％ of the S3 group (2/17),and 3.12％ of the total 64 cases (2/64).Conclusions Although the incidence rate of DGF was higher in the steatosis liver donor groups than the S0 group,there was no correlation in the mortality rate of the S1-S3 group within one year of transplantation.Attentions should be paid to the treatment of complications after steatosis liver transplantation.By minimizing ischemia-reperfusion injury,improving microcirculation,strengthening routine therapy and reducing the amount of immunosuppression,the same results could be achieved using steatosis donor liver and normal liver for transplantation.
