CAJ | 학술논문

目的：分析少见病因致术后远期再次肝移植患者的临床资料，总结首次肝移植术后远期再次行肝移植的手术指征、技巧及免疫抑制方案的选择。方法首次肝移植术后再次行肝移植患者5例，再次肝移植原因为慢性排斥反应4例、特发性门静脉高压1例。5例于首次肝移植术后6～14个月行再次肝移植，均采用经典原位肝移植术。4例术后免疫抑制方案为普乐可复（FK506）、吗替麦考酚酯（MMF）和激素三联免疫抑制方案，1例采用环孢素加激素。结果术后随访1年，4例治愈；1例术后发生肺部感染，因呼吸衰竭合并移植肝功能衰竭于术后1周死亡。1例术后发生胆管吻合口狭窄，经胆管介入治疗后好转。采用免疫抑制方案后，患者均未发生急性排斥反应，无相关并发症发生。结论对于首次肝移植术后发生慢性排斥反应或特发性门静脉高压的患者，应考虑行再次肝移植手术。控制术中出血、熟练掌握血管及胆管重建技术可提高手术成功率。再次肝移植术后选择合适的免疫抑制方案有助于提高患者存活率。
목적：분석소견병인치술후원기재차간이식환자적림상자료，총결수차간이식술후원기재차행간이식적수술지정、기교급면역억제방안적선택。방법수차간이식술후재차행간이식환자5례，재차간이식원인위만성배척반응4례、특발성문정맥고압1례。5례우수차간이식술후6～14개월행재차간이식，균채용경전원위간이식술。4례술후면역억제방안위보악가복（FK506）、마체맥고분지（MMF）화격소삼련면역억제방안，1례채용배포소가격소。결과술후수방1년，4례치유；1례술후발생폐부감염，인호흡쇠갈합병이식간공능쇠갈우술후1주사망。1례술후발생담관문합구협착，경담관개입치료후호전。채용면역억제방안후，환자균미발생급성배척반응，무상관병발증발생。결론대우수차간이식술후발생만성배척반응혹특발성문정맥고압적환자，응고필행재차간이식수술。공제술중출혈、숙련장악혈관급담관중건기술가제고수술성공솔。재차간이식술후선택합괄적면역억제방안유조우제고환자존활솔。
Objective To analyze the patients'clinical data of re-operation of liver re-transplantation caused by rare etiology and to discuss the choice of the indications, skills and immunosuppression of late liver transplantation. Methods Five cases of patients after liver transplantation for the first time receiving liver re-transplantation were se-lected.The indications consisted of chronic rejection (4 cases) and idiopathic portal hypertension (1 case).Five pa-tients after liver transplantation for the first time received liver re-transplantation in 6-14 months, and all cases adopt the classic orthotopic liver transplantation ( OLT) .The postoperative immunosuppression schemes of 4 cases were the triple immunosuppressive therapy of tacrolimus (FK506), mycophenolate mofetil (MMF) and hormone; and 1 case applied cyclosporin combined with hormone.Results After one-year follow-up, four patients were cured, and one patient died on week after liver re-transplantation because of poor graft function and respiratory failure.One case had biliary stenosis and then was improved by interventional radiology treatment.no complications and all in good condi-tion.No acute rejection and related complications were found in the postoperative immunosuppression.Conclusions As for patients who received liver transplantation for the first time having chronic rejection and idiopathic portal hyper-tension, late liver re-transplantation should be considered.Controlling the intraoperative bleeding and being familiar with vascular and bile duct reconstruction technique may improve the successful rate of surgery.For patients who re-ceived re-operation of liver re-transplantation, doctors should choose appropriate immunosuppressive scheme, which will help to improve the survival rate of patients.