CAJ | 학술논문

目的：总结公民逝世后器官捐献供肝用于肝移植的临床经验及疗效分析。方法回顾性分析2007年1月至2014年12月中国人民解放军第303医院收治的31例公民逝世后器官捐献肝移植病例的临床资料。结果31例供体中符合中国标准Ⅰ类8例、Ⅱ类3例、Ⅲ类20例。按规范器官获取流程取得供肝。供肝的热缺血时间为2～13 min，平均为9 min；冷缺血时间为240～600 min，平均为350 min。31例受体均顺利完成肝移植手术。其中29例受体恢复良好，肝功能逐渐恢复，未出现血栓形成、排斥反应，4例出现胆道狭窄并发症，经胆道支架置入术后引流通畅；重症监护室（ICU）停留时间平均8 d，术后住院时间平均21 d，病情稳定后出院。受体总体存活率为81％，1例术后2 d 死于原发性肝脏无功能，1例死于术后肺部感染，4例肿瘤受者死于肿瘤复发转移。结论公民逝世后器官捐献可以扩大供肝来源且近期效果良好。逐渐完善捐献供体器官功能保护措施，严格掌握供者适应证、加强器官功能评估、缩短热冷缺血时间，是改善临床效果的重要措施。
목적：총결공민서세후기관연헌공간용우간이식적림상경험급료효분석。방법회고성분석2007년1월지2014년12월중국인민해방군제303의원수치적31례공민서세후기관연헌간이식병례적림상자료。결과31례공체중부합중국표준Ⅰ류8례、Ⅱ류3례、Ⅲ류20례。안규범기관획취류정취득공간。공간적열결혈시간위2～13 min，평균위9 min；랭결혈시간위240～600 min，평균위350 min。31례수체균순리완성간이식수술。기중29례수체회복량호，간공능축점회복，미출현혈전형성、배척반응，4례출현담도협착병발증，경담도지가치입술후인류통창；중증감호실（ICU）정류시간평균8 d，술후주원시간평균21 d，병정은정후출원。수체총체존활솔위81％，1례술후2 d 사우원발성간장무공능，1례사우술후폐부감염，4례종류수자사우종류복발전이。결론공민서세후기관연헌가이확대공간래원차근기효과량호。축점완선연헌공체기관공능보호조시，엄격장악공자괄응증、가강기관공능평고、축단열랭결혈시간，시개선림상효과적중요조시。
Objective To summarize the clinical experience and curative effect analysis of liver transplantation from donation after citizen's death.Methods Clinical data of 31 cases of liver transplantation from donation after citizen's death in the 303 rd Hospital of People's Liberation Army were retrospectively studied.Results Among the 31 donors,8 donors met ClassⅠof Chinese Standard,3 met Class Ⅱand 20 met Class Ⅲ.The liver graft was obtained according to the standardized organ procurement process.The warm ischemia time of the liver graft was 2-13 min with the average of 9 min and the cold ischemia time was 240-600 min with the average of 350 min. Thirty-one recipients underwent the liver transplantation successfully. Twenty-nine recipients recovered well and the liver function gradually recovered without thrombosis and rejection.Four recipients developed biliary stricture and the drainage was unobstructed after biliary stent placement.The average stay time in intensive care unit (ICU)was 8 d and the average length of stay after transplantation was 21 d.The recipients were discharged when the conditions were stable.The overall survival rate of the recipients was 81%.One recipient died of primary liver dysfunction at 2 d after transplantation,one recipient died of postoperative pulmonary infection and four tumor patients died of tumor recurrence and metastasis.Conclusions Donation after citizen's death may expand the source of liver grafts and the short term effect is good.To gradually improve function protective measures for donor organs,to strictly control indications of donors,to strengthen the assessment of organ function and to shorten warm and cold ischemia time are important measures to improve clinical effect.