CAJ | 학술논문

目的探讨公民逝世后器官捐献(DCD)供肝在原发性肝癌患者抢救性肝移植中的应用效果.方法回顾性分析2010年10月至2013年12月施行的12例DCD供肝行抢救性肝移植的临床资料.供者分别为中国一类1例、中国二类2例、中国三类9例,其中中国三类供者均采用体外膜肺氧合技术(ECMO)减少热缺血时间.12例抢救性肝移植受者中,6例符合米兰标准、3例符合美国加州大学旧金山分校标准、3例符合杭州标准,均采用原位肝移植术,其中11例行胆管端端吻合,1例行胆肠吻合.所有受者获定期随访.结果 12例受者均顺利完成手术,均未发生原发性移植肝无功能和移植肝功能恢复延迟.术后早期发生并发症4例,其中2例死亡,2例经二次手术后恢复出院.10例受者长期存活,其中肿瘤复发2例,经积极治疗后带瘤存活,受者最长存活时间为42个月,均未出现缺血性胆道狭窄等远期并发症.结论越来越多DCD供肝应用于肝癌患者抢救性肝移植的治疗.把握好抢救性肝移植的特点,根据病情选择合适的DCD供肝,技术上合理的使用ECMO保护供肝质量,是保证DCD供肝应用于抢救性肝移植安全、有效的关键.
목적 탐토공민서세후기관연헌(DCD)공간재원발성간암환자창구성간이식중적응용효과.방법 회고성분석2010년10월지2013년12월시행적12례DCD공간행창구성간이식적림상자료.공자분별위중국일류1례、중국이류2례、중국삼류9례,기중중국삼류공자균채용체외막폐양합기술(ECMO)감소열결혈시간.12례창구성간이식수자중,6례부합미란표준、3례부합미국가주대학구금산분교표준、3례부합항주표준,균채용원위간이식술,기중11례행담관단단문합,1례행담장문합.소유수자획정기수방.결과 12례수자균순리완성수술,균미발생원발성이식간무공능화이식간공능회복연지.술후조기발생병발증4례,기중2례사망,2례경이차수술후회복출원.10례수자장기존활,기중종류복발2례,경적겁치료후대류존활,수자최장존활시간위42개월,균미출현결혈성담도협착등원기병발증.결론 월래월다DCD공간응용우간암환자창구성간이식적치료.파악호창구성간이식적특점,근거병정선택합괄적DCD공간,기술상합리적사용ECMO보호공간질량,시보증DCD공간응용우창구성간이식안전、유효적관건.
Objective To investigate the application and clinical value of donation after citizens death (DCD) in salvage liver transplantation (SLT).Method The clinical data of 12 recipients who underwent SLT from DCD of 12 donors at the Guangzhou General Hospital of Guangzhou Military Area from October 2010 to December 2013 were retrospectively analyzed.Of the donors,there was one case of type of China-Ⅰ,2 cases of the type of China-Ⅱ and 9 cases of the type of China-Ⅲ.Extracorporeal membrane oxygenation (ECMO) was applied to donation after brain and cardiac death to avoid warm ischemia.Of the recipients,6 met the Milan criteria,3 UCSF(The University of California,San Francisco) criteria and 3 Hangzhou criteria respectively.Orthotopic liver transplantation was performed on recipients.Eleven recipients received end-to-end anastomosis of the bile duct and followed up regularly.Result Liver transplantation was successfully performed on all recipients.No mortality during operation,no recovering delay and non-function of the transplanted liver occurred.Postoperative complications occurred in 4 cases,2 patients died,and 2 patients recovered and discharged after the second surgery.Ten recipients had a long-term survival.Two cases of hepatocellular carcinoma (HCC) recurrence were still alive after active treatment.The longest survival time was 42 months.All of them had no long-term complications such as biliary stricture.Conclusion The role and status of SLT in the treatment of HCC has become increasingly,and there will be more and more use of DCD donor in SLT.To ensure the DCD donors safely and effectively applied in SLT,we should grasp the characteristics of SLT,choose the appropriate DCD donor according to recipients,and rationally use the ECMO to protect the graft quality.