摘要目的 比较首次肝移植术后因移植肝失功实施早期和晚期再次肝移植的疗效并总结临床经验.方法 回顾性分析2004年1月至2009年7月间接受再次肝移植手术的36例患者的临床资料,包括早期再次肝移植17例和晚期再次肝移植19例.早期和晚期再次肝移植患者的年龄分别为(45±13)岁和(48±10)岁,与首次肝移植的时间间隔分别为(49±54)d和(514±342)d.结果 胆道并发症是早期再次肝移植和晚期再次肝移植的主要适应证.其他常见的适应证包括早期再次肝移植的血管并发症和晚期再次肝移植的原发病复发.除了MELD评分外,两组再次肝移植术中出血量、冷缺血时间、手术时间和围手术期病死率的差异均无统计学意义.早期再次肝移植中有8例患者死亡,其中3例死于脓毒症相关性疾病,3例死于多器官功能衰竭;晚期再次肝移植中有10例患者死亡,其中4例死于脓毒症相关性疾病,3例死于肝癌的复发.早期和晚期再次肝移植的l、2年的生存率分别为52.9％、41.2％和63.2％、52.6％,差异无统计学意义(P＞0.05).结论 早期再次肝移植和晚期再次肝移植治疗移植肝失功的疗效相当.手术适应证及时机的正确把握、娴熟的手术技巧以及围手术期有效的抗感染治疗是提高再次肝移植患者总体存活率的关键.

abstractsObjective To compare early and late orthotopic liver retransplantation (re-OLT) for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.Methods The clinical data of 36 re-OLTs from January 2004 to July 2009 were analyzed retrospectively,consisting of the first group with 17 cases of early re-OLT and the second group with 19 cases of late re-OLT.The average ages were (45 ± 13) years and (48 ± 10) years,and the time intervals were (49 ±54) days and (514 ±342) days in early re-OLT group and late re-OLT group,respectively.Results Biliary tract complications were the main indications for early re-OLT and late re-OLT.Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT.No significant differences were found between the groups with regard to the volume of bleeding during operation,cold ischemia time,operative duration and perioperative mortality except the MELD score.Outcome was fatal for 8 patients in early re-OLT and 10 patients in late re-OLT.Three deaths were due to severe sepsis-related disease,3 deaths due to multiple organ failure in early re-OLT and 4 deaths due to severe sepsis-related disease,3 deaths due to recurrence of HCC in late re-OLT.One and 2-year actuarial survival rates after re-OLT were 52.9％ and 41.2％,respectively,for patients in early re-OLT,and 63.2％ and 52.6％,respectively,for patients in late re-OLT.No significant differences were found regarding survival rates between the two groups( P ＞ 0.05 ).Conclusions The similar clinical results can be achieved in early and late re-OLT.Proper indications and optimal operation timing,experienced surgical procedures and effective perioperative anti-infection strategy contribute to the improvement of the overall survival rate of the patients after re-OLT.