30例原位肝移植手术临床分析

目的总结原位肝移植手术的临床经验,探讨提高肝移植手术效果的措施。方法回顾分析2003年12月~2006年3月30例原位肝移植患者的临床资料,均采用同种异体(尸体供肝)原位全肝移植,其中经典式24例,背驮式6例。结果30例手术全部成功,供肝热缺血时间平均4.5 m in,冷缺血时间5 h。围术期死亡3例。与手术相关主要并发症有:腹腔内出血4例,门静脉狭窄2例,胆道吻合口狭窄1例、胰漏1例、胸腔积液5例。27例获随访3~30个月,1例术后3月死于胆道铸型综合征并感染,肝癌复发2例。结论确保供肝质量是肝移植成功的前提,良好的血管和胆管重建技术是肝移植手术成功的关键,专业化的围手术期处理可有效地减少并发症的发生。

Clinical Analyze of Orthotopic Liver Transplantation in 30 Cases

Objective To summarize the clinical experience of liver transplantation in the treatment of end-stage liver diseases.Methods From December 2003 to March 2006,there were 30 patients underwent liver transplantation(orthotopic liver transplantation in 24 cases,piggyback liver transplatation in 6 cases,cadaveric donor).The data from those patients were retrospectively analyzed.Result All cases were successfully conducted.The warm ischemia duration was 4.5 min,cold ischemia was 5 hours.There were 3 cases of perioperative deaths.Surgical complications were intra-abdominal hemorrhage in 4 cases,portal vein stricture in 2 cases,biliary anastomotic stricture in 1 case,pancreatic fistula in 1 case and pleural effusion in 5 cases.1 case died of biliary tree cast syndrome and combined infection,2 cases got recurrence of liver cancer.Conclusion The successful liver transplantation relies on good quality of liver graft.Idealized technique of vascular and bile duct reconstruction is the key factor of liver transplantation.Properly postoperative management can effectively reduce the complications of operation.