摘要目的 总结重症肝炎患者行原位肝移植或肝肾联合移植的结果,探讨肝肾联合移植的手术适应证.方法 分析52例重症肝炎患者单纯行原位肝移植(orthotopic liver transplantation,OLT)和肝肾联合移植(combined liver-kidney transplantation,CLKT)两组患者死亡率、术后肾功能不全的发生率、ICU天数、住院天数等.结果 CLKT组患者术前肾功能明显差于OLT组,术后发生严重感染的患者明显多于OLT组.但OLT组中28例(70％)患者术后早期发生肾功能不良,其中11例需血液透析；而CLKT组患者中需血液透析仅2例,两组比较差异有统计学意义(P＜0.01).CLKT组患者在围手术期2例(16.7％)死亡.OLT组围手术期死亡16例(40％),其中死于急性肾衰9例,两组死亡率比较差异有统计学意义(P＜0.01).结论 重症肝炎患者若术前肾功能较差,术后易并发严重感染,肝移植后急性肾衰的发病率和死亡率较高,可考虑行CLKT术.

abstractsObjective To compare orthotopic liver transplantation (OLT)and combined liverkidney transplantation (CLKT) in the treatment of severe hepatitis B.Methods In this study 52 patients of severe hepatitis B were allocated to OLT (40 cases) or CLKT( 12 cases) at our department from Jan.2001 to Sep.2005.The perioperative complications and the result of follow-up were analyzed.Results The preoperative renal functions in CLKT cases were severer than that in OLT cases.Postoperative severe infection was more common in CLKT cases than that in OLT cases.In OLT group 28 patients (70％)suffered from early posttransplant renal dysfunction,among them 11 patients needed dialysis,whilst there were 2 (16.7％ ) patients who needed dialysis in CLKT group (P ＜0.01 ).The posttransplant mortality in OLT group was 40％ ( n =16),significantly higher than that in CLKT ( 16.7％,n =2) ( P ＜ 0.01 ).In OLT group,9 cases developed severe renal failure and died.No one died of renal failure in CLKT group.Conclusions The prognosis is more favorable to perform CLKT in patients who suffered from severe hepatitis B with chronic renal dysfunction before transplantation.