摘要目的 探讨急性肝功能衰竭患者行肝移植的手术时机及预后影响因素.方法 回顾性分析中山大学附属第一医院2005年3月至2010年6月收治的50例因急性肝功能衰竭行肝移植手术患者的临床资料.按手术效果分为预后良好组和预后不良组,总结术前临床及生化等指标分别行单因素及多因素分析,筛选与围手术期死亡相关的危险因素,指导手术时机的选择.结果 50例行肝移植术的患者中,围手术期死亡11例,分别死于肺部感染5例、肾功能衰竭3例、原发性移植物无功能1例、消化道出血1例、多器官功能衰竭1例.围手术期、术后1、3年生存率分别为78％、74％、72％.单因素分析提示患者年龄、总胆红素、凝血酶原时间、INR、肌酐、肝性脑病分期、MELD评分在预后良好组和预后不良组之间存在显著差异；多因素分析提示年龄≥65岁、INR≥3.5、肌酐≥2.5 mg/dl、MELD≥40分是影响围手术期预后的独立危险因素.结论 肝移植是治疗急性肝功能衰竭的有效办法,把握恰当的手术时机可使患者获得较高的生存率.

abstractsObjective To explore the optimal timing of liver transplantation for acute liver failure,and analyze relative risk factors affecting patients' prognosis.Methods We retrospectively analyze perioperative clinical data of 50 patients suffering from acute liver failure who underwent liver transplantation between March 2005 and June 2010 in Organ Transplantation Center,the First Affiliated Hospital of Sun Yat-sen University.Patients were divided into survival group and death group.Clinical data before operation were collected and analyzed by univariate and multivariate analysis,respectively.Risk factors influencing the perioperative mortality were selected and were used to direct the operation time.Results There were 50 patients who underwent liver transplantation and 11 cases died during perioperative phase.Five patients died of respiratory infection,three of acute renal failure,one of digestive tract hemorrhage,one of primary allograft failure and one of multiple organ failure.The perioperative,one-year and three-year survival rate were 78％,74％ and 72％ respectively.In the univariate analysis,age,bilirubin level,prothrombin time,creatinine level,grade of encephalopathy and MELD score were found to be significantly different between survival group and death group.The multivariate analysis revealed that age≥65 y,INR ≥3.5,creatinine level ≥ 2.5 mg/dl and MELD score ≥ 40 were independent risk factors affecting survival.Conclusions Liver transplantation is an effective treatment of choice for acute liver failure.Appropriate timing of transplantation helps achieve a high survival rate.