改良背驮式与经典背驮式肝移植的临床对照研究

目的 对比研究经典背驮式肝移植和改良背驮式肝移植两种术式的临床特点,探讨其优缺点.方法 自2003年2月至2006年8月,对37例肝炎后肝硬化和急性重症肝炎病人施行了肝移植术,男30例,女7例;年龄18~62岁,平均41.7岁.原发病分别为:乙型肝炎后肝硬化35例,急性重症肝炎2例,乙型肝炎病毒表面抗原(HBsAg)均阳性.手术方式采用经典背驮式A组11例,改良背驮式B组26例,37例手术全部成功.结果 改良背驮式肝移植组的手术时间短,术中出血输血量少,医疗费用少.结论 改良背驮式肝移植技术具有简化手术操作,缩短手术时间,减少术后并发症,医疗费用少等优点.     

大鼠原位肝移植不同术式的探讨

采用“套管法”改进后的“缝合法”行大鼠原位肝移植８０例“套管法”吻合肝上腔静脉平均为８．６分钟，手术成功率９０％，一周存活率１０％。“缝合法”吻合肝上腔静脉平均为１０分钟，手术成功率９３．３％，一周存活率８３．３％，结果提示，“套管法”存活率低，缺乏实验应用价值，而改进的的“缝合法”既简化了手术，又缩短了手术时间和无肝期。     

大鼠原位肝移植模型不同术式改进的研究

目的比较两种改进后大鼠原位肝移植模型建立的优缺点.方法对三套袖法的修肝技术及套管制作进行改进,实施大鼠原位肝移植30例,采用改进的缝合法实施大鼠原位肝移植70例.结果三袖套法手术成功率80%,1周存活率8%,缝合法手术成功率90%,1周存活率72%.结论改进后的三袖套法虽然明显缩短手术时间及无肝期,但手术后并发症多,缺乏实际应用价值,改进后的缝合法是建立稳定大鼠肝移植模型的有效方法.     

活体肝移植几种术式探讨(附50例报告)

目的探讨活体肝移植不同术式的临床应用。方法对1995年1月至2006年3月我科完成的50例活体肝移植的临床资料进行回顾性分析,探讨活体肝移植不同术式的临床应用和保障供体安全的策略等问题。结果本组资料中,所有供体术后均顺利康复,均未出现严重并发症。适应证：良性终末期肝硬化47例,恶性肿瘤3例。44例受体健在,手术死亡3例,3例死于远期并发症。本组供体右半肝（不包括肝中静脉）9例,右半肝（包括肝中静脉）1例,左半肝（包括肝中静脉）36例,左半肝或左外叶（不包括肝中静脉）4例。结论活体肝移植是解决目前全球供肝短缺问题的重要途径之一。活体肝移植手术过程复杂,根据临床实际选择合理手术方式是保证供体安全和提高手术成功率的关键。     

原位肝移植术的麻醉分析

肝移植手术早已成为欧美发达国家治疗终末期肝病的重要手段之一,近年来我国亦有长足的进步和发展,仅我院自2002年4月至2005年9月已完成肝移植手术520余例,均取得满意效果。本文对我院早期完成的100例原位肝移植术的麻醉进行分析,以探讨肝移植手术中麻醉管理的规律。     

不同术式大鼠原位肝移植模型的比较

目的比较二种不同术式大鼠原位肝移植模型的优劣,建立一种稳定的大鼠肝移植模型。方法采用二袖套法完成大鼠原位肝移植40例,采用三袖套法施行大鼠原位肝移植20例。结果二袖套法手术成功率为92．5％（37／40）,1周存活率为89．2％（33／37）。三袖套法手术成功率为85％（17／20）,1周存活率为11．8％（2／17）。结论大鼠原位肝移植二袖套法较三袖套法远期存活率高,并发症少,是一种稳定可靠的大鼠肝移植模型。     

重建肝动脉血供大鼠原位肝移植模型的术式探讨

目的　探讨重建肝动脉血供的大鼠原位肝移植 (OLT)模型的手术操作方法 ,并对几种术式的效果进行了比较。方法　采用重建肝动脉血供的大鼠原位肝移植 60例 ,其中动脉“袖管式微血管缝合法”2 0例 ,动脉“套管法”2 0例和动脉“支架法”2 0例。同期行不吻合肝动脉的经典“二袖套法”96例。结果　各组手术时间 (包括供体手术 ) :“袖管式缝合法”(118.3± 12 .9)min ,“套管法”(10 6.2± 11.6)min ,“支架法”(93 .8± 10 .2 )min ,经典“二袖套法”(88.2± 9.6)min。无肝期均控制在 (2 0 .0± 2 .5 )min。经典“二袖套法”大鼠 1周存活率为 86.5 % (83 /96) ,重建肝动脉血供的大鼠 1周存活率为 86.7% (5 2 /60 )。胆道并发症发生率分别为 17.7% (17/96)和 6.7% (4 /60 )。结论　肝动脉重建的OLT本身并不能延长肝移植大鼠的生存时间 ,而肝动脉重建后可以减少术后胆道并发症的发生率。     

背驮式原位肝移植术

标准的原位肝移植手术，受体的肾静脉以上至横隔以下的腔静脉段，作为肝切除的一部分而被切除。有时，由于静脉侧支循环的建立，该段腔静脉后的分离和随后的止血都极困难。所以，1989年Tzakis等报道了一种保留下腔静脉全长的原位肝移植手术，称为背驮式原位肝移植术（PiggybackorthotopicLiverTransplantation）。此后，学者们对这种术式又进行了某些改良，使得这一技术更趋完善。有人认为，背驮式手术技术是肝移植的最重要发展项目之一。我院于1996年5月至今，已分别对成人和儿童3例患者成功地施行了背驮式原位肝移植术。1手术方法我院3…     

肿瘤切除联合肝移植治疗消化道原发性肿瘤伴肝转移

目的探讨在根治性切除原发性肿瘤的前提条件下，联合应用肝移植治疗肝转移癌是否为一种合理性的策略。方法借鉴国外的相关经验，实施结、直肠癌Dixon术联合原位肝移植2例次，胃癌D4根治术联合原位肝移植1例次。结果3例患者中，有2例分别于术后4个月和8个月死于肿瘤复发；1例结、直肠癌患者无瘤存活16个月余。结论对部分具有较好生物学特性的消化道肿瘤伴肝转移，原发性肿瘤切除联合肝移植可作为少数患者获得治疗机会的一种选择。     

Pure laparoscopic living donor liver transplantation: Dreams come true

Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24-year-old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.

     

25例原位肝移植的临床总结

目的: 总结肝脏移植治疗不同终末期肝病的经验.方法: 对23例原位肝移植与2例肝、肾联合移植的临床资料进行回顾性分析.手术方式均采用同种异体原位肝移植,包括经典原位,经典背驮及改良背驮式.结果: 全组死亡7例,存活18例.术后发生排斥反应、感染及脑血管意外等并发症.术后服用拉米呋啶的20例乙型肝炎患者3例复发.结论: 开展肝移植的初期应严格掌握适应证,选择条件较好的受者;术式的改进及围手术期的严密监测与正确处理、并发症的防治是肝移植成功的重要条件.     

Low rejection rates with tacrolimus-based dual and triple regimens following liver transplantation

We studied the outcome of 345 liver transplant patients who received tacrolimus-based immunosuppressive therapy either as a dual regimen (with corticosteroids, n=172) or as a triple regimen (with corticosteroids and azathioprine, n=173) for 3 months after transplantation (3-month cohort). A further analysis was conducted for the first 195 patients randomised (dual n=100, triple n=95) who were followed up for 12 months after transplantation (12-month cohort). For the 3-month cohort, patient survival was 90.7% (dual) and 91.9% (triple), graft survival after 3 months was 88.4% (dual therapy) and 89.6% (triple therapy). Acute rejections were experienced by 67/172, 39.0% of patients on dual therapy and by 60/173, 34.7% of patients on triple therapy; corticosteroid-resistant rejections were reported in 9 patients (5.2%) in either treatment group. The overall safety profile was similar for the two treatment groups. Significant differences, however, were found for thrombocytopenia (dual 13/172, 7.6%, triple 37/173, 21.4%, p<0.001) and leukopenia (dual 4/172, 2.3%, triple 24/173, 13.9%, p<0.001). For the 12-month cohort, patient survival was 85.6% (dual) and 88.4% (triple) after 1 year. Graft survival was 81.7% (dual) and 85.2% (triple) 12 months after transplantation. Acute rejections were reported for 38/100, 38.0% of patients on dual therapy and 36/95, 37.9% of patients on triple therapy, corticosteroid-resistant rejections were 7/100, 7.0% (dual) and 7/95, 7.4% (triple) of patients. In the 12-month cohort, no significant differences in the safety profiles of the treatment groups were found. We conclude that both tacrolimus-based dual and triple drug regimens provide effective and safe immunosuppression following orthotopic liver transplantation.     

儿童肝移植

Pediatric liver transplantation has long been developed in the western world.Currently,favorable outcomes after liver transplantation have been achieved in pediatric recipients and the postoperative 5-...     

辅助性肝移植研究进展

辅助性肝移植足指住保留受体自身全部或部分肝脏的情况下,将供肝植入受体体内.根据供肝植入部位不同,可分为异位辅助性肝移植和原位辅助性肝移植;根据植入肝体积的多少,可分为全肝辅助性肝移植和部分肝辅助性肝移植;供肝可来源于脑死亡供体也可以来源于活体供体.山于原位辅助性肝移植只能移植部分肝脏,故通常称为原位辅助性部分肝移植.辅助性肝移植伴随着肝移植的发展而不断发展,虽然还存在许多尚待解决的问题,但辅助性肝移植独特的优势再次引起肝移植界的广泛关注.     

107例同种原位肝移植肝动脉重建的体会

目的探讨肝脏移植手术中肝动脉重建技术的要点和影响肝动脉重建结果的因素。方法回顾性总结 10 7例肝脏移植患者的临床资料 ,分析肝脏移植手术中可能影响肝动脉重建的因素 ,以及肝动脉重建的技术要点。结果肝脏移植术中肝动脉重建与外科手术方式相关。供肝动脉的完整性、供体受体动脉的重建方式以及显微外科技术的应用是影响肝动脉重建结果的重要因素。结论供肝动脉的质量、动脉的重建方式和显微外科技术的应用是肝动脉重建的关键。