CAJ | 학술논문

目的探讨自体肝移植治疗常规手术难以切除的肝脏占位性病变的临床价值.方法回顾性分析2005年5月至2011年12月武汉大学中南医院收治的36例自体肝移植患者的临床资料,分析患者术前评估情况,术中情况和术后情况.采用门诊或电话方式随访,随访时间截止2013年3月.Kaplan-Meier 法绘制生存曲线.结果 36例患者术前肝功能Child-Pugh分级,A级34例、B级2例.HBsAg阳性20例、阴性16例.36例患者均施行了半离体自体肝移植,手术时间为(8.3±1.5)h,无肝期为(245±12) min,术中中位出血量为600 ml,其中2例在开放肝脏血流后并发严重心律失常,其余患者手术顺利.术后肝功能恢复时间为(10±5)d.中位住院时间为28.5 d,术后中位住院时间为24.0 d.ALT、AST、TBil达峰值时间分别为(1.7±0.8)d、(1.3±0.6)d和(2.5±1.4)d.术后34例患者获得随访,随访率为94.4％(34/36),中位随访时间为4年.13例良性疾病患者,1例侵犯肝门部胆管及胆总管包虫病患者术后5个月复发,经RFA治疗后带病生存.20例肝癌患者术后肿瘤复发转移9例,其中1例失访,7例死亡,1例已生存5.4年.2例右肾癌癌栓蔓延至肝静脉出口平面患者,1例失访,1例已生存4.4年.1例胰腺癌肝转移术后复发患者,术后5个月肝脏转移瘤复发.36例患者自体肝移植术后1、2、3年生存率分别为75％、71％、68％,其中恶性肿瘤患者术后1、2、3年生存率分别为65％、59％、54％.结论自体肝移植患者经过完善的术前评估、严格筛选手术适应证、充分的术前准备、改进的手术技术和肝脏灌注方法,可获得较好的手术效果,术后得以长期生存.
목적 탐토자체간이식치료상규수술난이절제적간장점위성병변적림상개치.방법 회고성분석2005년5월지2011년12월무한대학중남의원수치적36례자체간이식환자적림상자료,분석환자술전평고정황,술중정황화술후정황.채용문진혹전화방식수방,수방시간절지2013년3월.Kaplan-Meier 법회제생존곡선.결과 36례환자술전간공능Child-Pugh분급,A급34례、B급2례.HBsAg양성20례、음성16례.36례환자균시행료반리체자체간이식,수술시간위(8.3±1.5)h,무간기위(245±12) min,술중중위출혈량위600 ml,기중2례재개방간장혈류후병발엄중심률실상,기여환자수술순리.술후간공능회복시간위(10±5)d.중위주원시간위28.5 d,술후중위주원시간위24.0 d.ALT、AST、TBil체봉치시간분별위(1.7±0.8)d、(1.3±0.6)d화(2.5±1.4)d.술후34례환자획득수방,수방솔위94.4％(34/36),중위수방시간위4년.13례량성질병환자,1례침범간문부담관급담총관포충병환자술후5개월복발,경RFA치료후대병생존.20례간암환자술후종류복발전이9례,기중1례실방,7례사망,1례이생존5.4년.2례우신암암전만연지간정맥출구평면환자,1례실방,1례이생존4.4년.1례이선암간전이술후복발환자,술후5개월간장전이류복발.36례환자자체간이식술후1、2、3년생존솔분별위75％、71％、68％,기중악성종류환자술후1、2、3년생존솔분별위65％、59％、54％.결론 자체간이식환자경과완선적술전평고、엄격사선수술괄응증、충분적술전준비、개진적수술기술화간장관주방법,가획득교호적수술효과,술후득이장기생존.
Objective To study the clinical value of autologous liver tranplantation (ALT) for the treatment of liver occupying lesion which can not be resected by conventional techniques.Methods The clinical data of 36 patients who received ALT at the Zhongnan Hospital of Wuhan University from May 2005 to December 2011 were retrospectively analyzed.The preoperative evaluation,intra-and postoperative conditions of the patients were analyzed.All the patients were followed up via phone call or out-patient examination till March 2013.The survival curve was drawn by Kaplan-Meier method.Results The preoperative hepatic function of 34 patients was in ChildPugh grade A,and 2 in Child-Pugh grade B.The HBsAg was positive in 20 patients and negative in 16 patients.Thirty-six patients received ALT.The operation time was (8.3 ± 1.5)hours,and the anhepatic phase was (245 ±12)minutes,the median volume of intraoperative blood loss was 600 ml.The operation was successful except 2 patients suffered from severe arrhythmia.The mean time for hepatic function recovery after the operation was (10 ±5)days.The median time for hospital stay and postoperative hospital stay were 28.5 days and 24.0 days,respectively.The time for alanine transaminase,aspartate transaminase and total bilirubin to reach the peak level were (1.7 ± 0.8) days,(1.3 ± 0.6) days and (2.5 ± 1.4) days,respectively.Thirty-four patients were followed up with the rate of 94.4％ (34/36),and the median follow-up time was 4 years.Thirteen patients suffered from benign disease.One patient with hydatidosis invading the hilar bile duct and common bile duct had hydatidosis recurrence at postoperative month 5,and he received radiofrequency ablation.Of the 20 patients with hepatic cancer,9 had tumor recurrence or metastasis (1 missed follow-up,7 died and 1 survived for 5.4 years).Of the 2 patients with hepatic vein invaded by right renal carcinoma,1 missed follow-up and 1 survived for 4.4 years.One patient had hepatic metastatic tumor recurrence at postoperative month 5.The 1-,2-,3-year survival rates of the 36 patients were 75％,71％ and 68％,and the 1-,2-,3-year survival rates of patients with malignant tumor were 65％,59％ and 54％,respectively.Conclusion After comprehensive preoperative assessment,rigorous screening indications,adequate preoperative preparation and improved surgical techniques,ALT could reduce early postoperative mortality and lengthen the survival time.