摘要目的 探讨同种异体原位肝移植(orthotopic liver transplantation,OLT)治疗晚期肝泡状棘球蚴病(HAE)的适应证及临床疗效.方法 本研究回顾性分析四川大学华西医院2001年1月至2017年12月收治的12例晚期HAE接受OLT的受者的临床资料.本组12例HAE受者中男7例,女5例,年龄42岁(16～58岁),Child-Pugh评分A级2例,B级3例,C级7例,终末期肝病模型(MELD)评分19.5(8～23).结果 12例受者的OLT手术时间为(456.25±44.98)min,术中失血量1000 ml(600～4000 ml),无肝期时间79.17 min(79.17±10.01)min,住院时间29.5 d(15～58 d).12例受者随访时间为0～207个月,存活10例,死亡2例.死亡2例分别于术后23 d和32 d死于肺部感染和多器官功能衰竭.1例术后2年出现肺转移,术后4年出现脑转移.另1例受者术后3年发现肝内复发.其余8例受者肝内及肝外均未见新生病灶.结论 对于无法行根治性肝切除的晚期HAE患者,OLT是最有效的治疗方法.

abstractsObjective To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis (HAE) .Methods The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed .Among them ,there were 7 males and 5 females ,the age ranged from 16～58 years(median 42 years) .The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A ,3 class B and 7 class C ,and the median model for end-stage liver disease(MELD)score was 19 .5(8～23) .Results The mean time of OLT procedure and anhepatic phase in 12 patients were 456 .25(456 .25 ± 44 .98)min and 79 .17(79 .17 ± 10 .01)min respectively .The median intraoperative blood loss and hospital stay times were 1000 ml(600～4000 ml) ,and 29 .5(15 ± 58)days respectively . All the patients were followed-up for 0 months to 207 months .Among the 12 patients who underwent OLT ,2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT ,and multiple organ failure on day 32 post-OLT ,respectively .One case developed lung metastasis 2 years after operation ,and brain metastasis was found in the same patient after 4 years .The recurrence occurred 3 years after OLT in another patient ,no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients .Conclusions OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy .