肝脏移植: 中山医科大学器官移植中心的经验
Liver transplantation at the Sun Yat-Sen University of Medical Sciences in China
目的总结70例肝脏移植治疗不同终末期肝病的经验,探讨肝移植在治疗肝细胞癌(HCC)和重症乙型肝炎的疗效,以及评价拉米夫定对预防乙肝复发的应用价值.方法回顾性分析了自1993年4月至2000年12月本中心实施的70例肝移植临床资料.肝移植的主要指征是原发性肝癌(26例)、肝硬化(21例)、重症乙型肝炎(12例)、硬化性胆管炎(4 例)以及其它终末期肝病(7例).对12例重症性乙型肝炎患者应用拉米夫定治疗.采用多元回归分析确定影响肝移植预后的危险因素.结果 54例患者存活1个月以上,16例患者在移植术后30天内死亡,院内存活率为77.1%,肝功能属Child A级和B级的患者院内存活率明显高于Child C级患者(P<0 .05),小肝癌患者的疗效优于大肝癌患者.移植前APACEⅢ评分,腹水量以及血肌酐水平与肝移植预后有密切关系.在重症乙肝患者中,9例仍存活,存活时间为2-24个月,拉米夫定可有效抑制肝移植术后乙肝复发,且无明显的副作用. 结论本研究结果显示原位肝移植可使部分HCC病人获得治愈,部分病例可获得良好的姑息疗效. 病例选择对肝癌肝移植的预后极其重要;结果还提示肝移植作为一种治疗各种终末期肝病的手段是可行的.同时认为拉米夫定是一种疗效肯定,副作用小的预防肝移植术后乙肝病毒复发的药物.
更多Objectives To summarize the results of liver transplantation for various end-stage liver diseases at the Sun Yat-Sen University of Medical Sciences (SUMS), define the role of liver transplantation in the treatment of hepatocellular carcinoma and fulminant hepatitis B, and assess the efficiency of lamivudine on preventing HBV recurrence.Methods Seventy liver transplants performed at the SUMS between April 1993 and December 2000 were retrospectively analyzed. The main indications for liver transplant were hepatocellular carcinoma (26 cases), liver cirrhosis (21 cases), fulminant hepatitis B (12 cases), sclerosing cholangitis (4 cases) and other terminal liver diseases (7 cases). Lamivudine was used in twelve patients suffering from fulminant hepatitis B. Logistic multivariate regression analysis was applied to determine the risk factors predicting liver transplantation outcomes.Results Fifty-four patients survived for more than one month, and 16 patients died within 30 days after orthotopic liver transplantation (OLT). The overall hospital survival rate was 77.1%. The hospital survival rates in the Child's A and B patients were 87.5% and 83.3%, respectively. Those rates were superior to those of the Child's C patients (P<0.05). The outcome of patients with small hepatocellular carcinoma (HCC) was superior to that of patients with large HCC. Preoperative APACE Ⅲ scores, the severity of ascites and serum creatine level had independent influence on outcome. Of the patients with fulminant HBV infection, 9 recipients survived for a follow-up period of 2-24 months. Treatment with lamivudine monotherapy was both well tolerated and efficacious in patients with fulminant hepatitis B.Conclusions The results indicate that orthotopic liver transplantation could provide long-term cure and palliation for patients with HCC, and that patient selection is extremely important in predicting outcome. The results support the continued application of liver transplantation as a therapeutic modality for various end-stage liver diseases and that lamivudine is an effective and safe monotherapy in OLT for patients with HBV infection.
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