中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
9期
683-686
,共4页
门静脉高压症%肝移植%食管静脉曲张
門靜脈高壓癥%肝移植%食管靜脈麯張
문정맥고압증%간이식%식관정맥곡장
Portal hypertension%Liver transplantation%Esophageal varices
目的 探讨肝移植治疗肝硬化门静脉高压症的临床疗效.方法 回顾性分析2000年1月至2012年1月北京大学人民医院收治的181例肝硬化门静脉高压症患者的临床资料.肝移植手术适应证为反复发作上消化道大出血,经内、外科和介入治疗无效,或合并肝功能失代偿的门静脉高压症患者.根据患者情况选择行经典原位肝移植或背驼式肝移植.术中于移植肝植入前后分别经胃网膜右血管置入套管针,连接测压管测压.观察手术前后门静脉压力变化情况,术后并发症的发生情况.术后通过肝移植随访中心定期随访,并根据具体指标调整用药,随访时间截至2012年12月,监测患者食管静脉曲张再出血及生存情况.Kaplan-Meier法计算生存率,计量资料采用(x)±s表示,均值比较采用t检验.结果 181例患者中,65例行经典原位肝移植,116例行背驮式肝移植.手术时间为(485±97) min,术中出血量为(4 380±1 993) mL,无肝期时间为(56±24) min.157例患者留置T管,24例患者未留置T管.102例患者术中经胃网膜右静脉测量了肝移植前后的门静脉压力,术前门静脉压力为(32±11)cmH2O(1 cmH2O =0.098 kPa),术后门静脉压力为(21±6)cmH20,手术前后门静脉压力比较,差异有统计学意义(t=2.412,P<0.05).肝移植术后严重感染23例、急性肾衰竭20例、严重腹腔内出血6例、血管相关并发症5例和移植物原发无功能2例.181例患者均获得随访,随访时间为6 ~131个月.138例患者术后1年复查内镜或行上消化道造影检查,112例曲张静脉完全消失,其余26例较术前明显减轻,总改善率为85.71%(138/161).术后1年内4例患者出现了上消化道再出血,再出血率为3.70%(4/108),其中3例经止血药物或内镜治疗后得到缓解,1例死于再次出血导致的肝衰竭.随访患者术后1个月、1年及5年生存率分别为86.8%、84.9%、77.4%.23例死亡患者中,15例死于MODS,5例死于血管相关并发症(肝动脉血栓形成2例、门静脉血栓形成2例、腔静脉吻合口狭窄1例),2例死于原发性移植肝无功能,1例死于呼吸系统并发症.结论 肝移植是肝硬化门静脉高压症的有效治疗方式,降低门静脉压力效果好,再出血率低.
目的 探討肝移植治療肝硬化門靜脈高壓癥的臨床療效.方法 迴顧性分析2000年1月至2012年1月北京大學人民醫院收治的181例肝硬化門靜脈高壓癥患者的臨床資料.肝移植手術適應證為反複髮作上消化道大齣血,經內、外科和介入治療無效,或閤併肝功能失代償的門靜脈高壓癥患者.根據患者情況選擇行經典原位肝移植或揹駝式肝移植.術中于移植肝植入前後分彆經胃網膜右血管置入套管針,連接測壓管測壓.觀察手術前後門靜脈壓力變化情況,術後併髮癥的髮生情況.術後通過肝移植隨訪中心定期隨訪,併根據具體指標調整用藥,隨訪時間截至2012年12月,鑑測患者食管靜脈麯張再齣血及生存情況.Kaplan-Meier法計算生存率,計量資料採用(x)±s錶示,均值比較採用t檢驗.結果 181例患者中,65例行經典原位肝移植,116例行揹馱式肝移植.手術時間為(485±97) min,術中齣血量為(4 380±1 993) mL,無肝期時間為(56±24) min.157例患者留置T管,24例患者未留置T管.102例患者術中經胃網膜右靜脈測量瞭肝移植前後的門靜脈壓力,術前門靜脈壓力為(32±11)cmH2O(1 cmH2O =0.098 kPa),術後門靜脈壓力為(21±6)cmH20,手術前後門靜脈壓力比較,差異有統計學意義(t=2.412,P<0.05).肝移植術後嚴重感染23例、急性腎衰竭20例、嚴重腹腔內齣血6例、血管相關併髮癥5例和移植物原髮無功能2例.181例患者均穫得隨訪,隨訪時間為6 ~131箇月.138例患者術後1年複查內鏡或行上消化道造影檢查,112例麯張靜脈完全消失,其餘26例較術前明顯減輕,總改善率為85.71%(138/161).術後1年內4例患者齣現瞭上消化道再齣血,再齣血率為3.70%(4/108),其中3例經止血藥物或內鏡治療後得到緩解,1例死于再次齣血導緻的肝衰竭.隨訪患者術後1箇月、1年及5年生存率分彆為86.8%、84.9%、77.4%.23例死亡患者中,15例死于MODS,5例死于血管相關併髮癥(肝動脈血栓形成2例、門靜脈血栓形成2例、腔靜脈吻閤口狹窄1例),2例死于原髮性移植肝無功能,1例死于呼吸繫統併髮癥.結論 肝移植是肝硬化門靜脈高壓癥的有效治療方式,降低門靜脈壓力效果好,再齣血率低.
목적 탐토간이식치료간경화문정맥고압증적림상료효.방법 회고성분석2000년1월지2012년1월북경대학인민의원수치적181례간경화문정맥고압증환자적림상자료.간이식수술괄응증위반복발작상소화도대출혈,경내、외과화개입치료무효,혹합병간공능실대상적문정맥고압증환자.근거환자정황선택행경전원위간이식혹배타식간이식.술중우이식간식입전후분별경위망막우혈관치입투관침,련접측압관측압.관찰수술전후문정맥압력변화정황,술후병발증적발생정황.술후통과간이식수방중심정기수방,병근거구체지표조정용약,수방시간절지2012년12월,감측환자식관정맥곡장재출혈급생존정황.Kaplan-Meier법계산생존솔,계량자료채용(x)±s표시,균치비교채용t검험.결과 181례환자중,65례행경전원위간이식,116례행배타식간이식.수술시간위(485±97) min,술중출혈량위(4 380±1 993) mL,무간기시간위(56±24) min.157례환자류치T관,24례환자미류치T관.102례환자술중경위망막우정맥측량료간이식전후적문정맥압력,술전문정맥압력위(32±11)cmH2O(1 cmH2O =0.098 kPa),술후문정맥압력위(21±6)cmH20,수술전후문정맥압력비교,차이유통계학의의(t=2.412,P<0.05).간이식술후엄중감염23례、급성신쇠갈20례、엄중복강내출혈6례、혈관상관병발증5례화이식물원발무공능2례.181례환자균획득수방,수방시간위6 ~131개월.138례환자술후1년복사내경혹행상소화도조영검사,112례곡장정맥완전소실,기여26례교술전명현감경,총개선솔위85.71%(138/161).술후1년내4례환자출현료상소화도재출혈,재출혈솔위3.70%(4/108),기중3례경지혈약물혹내경치료후득도완해,1례사우재차출혈도치적간쇠갈.수방환자술후1개월、1년급5년생존솔분별위86.8%、84.9%、77.4%.23례사망환자중,15례사우MODS,5례사우혈관상관병발증(간동맥혈전형성2례、문정맥혈전형성2례、강정맥문합구협착1례),2례사우원발성이식간무공능,1례사우호흡계통병발증.결론 간이식시간경화문정맥고압증적유효치료방식,강저문정맥압력효과호,재출혈솔저.
Objective To investigate the clinical efficacy of liver transplantation for liver cirrhosis and portal hypertension.Methods The clinical data of 181 patients with liver cirrhosis and portal hypertension who were admitted to the People's Hospital of Peking University from January 2000 to January 2012 were retrospectively analyzed.The efficacy of liver transplantation for liver cirrhosis and portal hypertension was investigated.The indications of liver transplantation included repeated upper gastrointestinal hemorrhage,failure of medication,surgical treatment and interventional therapy,and portal hypertension combined with hepatic functional decompensation.Orthotropic liver transplantation or piggyback liver transplantation was selected according to the condition of the patients.The pressures of the portal vein were detected before and after the transplantation of the liver graft by the manometer tube.The incidence of postoperative complications was detected.Patients were followed up regularly till December 2012.The varices and rebleeding of the esophageal veins and the survival of the patients were monitored.The survival rates was calculated using the Kaplan-Meier method,and the measurement data were analyzed using the t test.Results Of the 181 patients,65 received orthotropic liver transplantation,and 116 received piggyback liver transplantation.The operation time,volume of blood loss and anhepatic phase were (485 ± 97) minutes,(4 380 ± 1 993) mL and (56 ± 24) minutes,respectively.T tube was placed in 157 patients.The portal vein pressure was detected in 102 patients.The portal vein pressures before and after liver transplantation were (32 ± 11) cmH2O (1 cmH2O =0.098 kPa) and (21 ± 6) cmH2O,respectively.There was significant difference in the portal vein pressure before and after liver transplantation (t =2.412,P < 0.05).Severe infection was detected in 23 patients,acute renal failure in 20 patients,severe abdominal bleeding in 6 patients,vascular complications in 5 patients and primary graft non-function in 2 patients after liver transplantation.A total of 181 patients were followed up for 6-131 months.One hundred and thirty-eight patients received endoscopy or upper gastrointestinal imaging at 1 year after liver transplantation.The varices were disappeared in 112 patients and alleviated in 26 patients,with the overall alleviation rate of 85.71% (138/161).Four patients were complicated with upper gastrointestinal rebleeding within 1 year after liver transplantation,and the rebleeding rate was 3.70% (4/108).The condition of 3 patients was alleviated by haemostatics and endoscopic treatment,and 1 patient died of liver failure caused by rebleeding.The 1-month,1-,5-year survival rates were 86.8%,84.9% and 77.4%,respectively.Twenty-three patients died.Fifteen patients died of multi-organ dysfunction syndrome,5 died of vascular complications (2 died of hepatic artery thrombosis,2 died of portal vein thrombosis and 1 died of anastomotic stricture of vena cava),2 died of primary graft non-function,and 1 died of respiratory complications.Conclusion Liver transplantation is an efficient method for the treatment of liver cirrhosis and portal hypertension with the advantages of low rebleeding rate and ideal efficacy of reducing portal vein pressure.