肝移植治疗终末期乙型肝炎肝硬化的临床探讨

目的：探讨肝移植治疗乙型肝炎肝硬化的手术时机和不同术式原位肝移植标准原位肝移植(SOLT)、背驮式原位肝移植(POLT)和改良背驮式原位肝移植(MPOLT)]的治疗效果。方法：分析5例乙型肝炎肝硬化病人接受6次肝移植手术(每种术式各2次，包括1例再次背驮式原位肝移植和1例肝肾联合移植)的病例资料。结果：5例中3例已分别存活19个月、5个月和5个月。1例因门静脉血栓复发再次行背驮式肝移植，于再次术后第7天死于多器官功能衰竭；另1例于术后第67天死于严重的肺部感染。术中各术式出血量分别为3500ml(SOLT)、4250ml(POLT)和1000ml(MPOLT)。结论：乙型肝炎肝硬化终末期患者是肝移植适应证。相对于SOLT和POLT，MPOLT术式具有出血少、手术时问短的优点。

Clinical discussion on the effect of liver transplantation for end-stage hepatitis-B cirrhosis

Objective:To investigate the timming of liver transplantation and the effect of different operation styles of OLT(standard orthotopic liver transplantation,SOLT;piggyback orthotopic liver transplantation,POLT;modified piggyback orthotopic liver transplantation,MPOLT) for hepatitis B cirrhosis.Methods:From Mar.2001 to May 2002,5 patients with hepatitis B cirrhosis underwent 6 operations of OLT(each style of OLT for two operations,including 1 case of piggyback retransplatation and 1 case combined liver kidney transplatation).Results:Three of 5 patients have survived for 19,5 and 5 months,respectively after operation. One patient died of MOF at the 7th post reoperative day after re transplantation owing to potal vein thrombosis and another one died of severe pulmonary infection at the 67th post operative day. The amount of bleeding during OLT operation is 3500 ml with SOLT,4250 ml with POLT and 1000 ml with MPOLT.Conclusion:End stage hepatitis B cirrhosis is an indication for OLT. The operation style of MPOLT shows several advantages including less bleeding,shorter operation time as compared with SOLT and POLT.