急症肝移植论文：27例急症肝移植临床报告.docVIP

急症肝移植论文：27例急症肝移植临床报告 【中文摘要】总结急症肝移植救治危重肝病患者的临床经验。方法：回顾性分析2005年1月至2010年10月我中心开展的27例次急症肝移植临床资料和随访结果。结果：本组资料中,术后康复出院20例,住院期间死亡7例；死亡病例中,4例死因为多器官功能衰竭(MODS),1例为肺部感染并ARDS,1例为脑水肿并呼吸抑制,1例为急性排斥反应。另有1例在术后第327天死于肝癌复发。所有患者术后住院期间死亡率为25.9%，术后6月和1年生存率分别为74.1%和70.4%。其中5例ABO血型不合肝移植,除1例肝癌患者死于MODS外,其余4例均康复。4例术前行人工肝支持治疗的患者,手术顺利,均康复出院。1例活体肝移植患者术后恢复良好,已健康存活27个月。统计分析发现,术前MELD评分,血肌酐水平以及病因与患者的预后相关(0.050.10); ABO血型相合组与ABO血型不合组生存率无统计学意义(P0.10)。结论：危重肝病患者行肝移植,风险相对较大,应选择合适的受者,以避免宝贵医疗资源的浪费；应加强围手术期处理,以提高手术的成功率和受者术后生存率；ABO血型不合和活体肝移植可以缩短危重患者等待供肝的时间,能取得良好的疗效,值得更广泛的研究和应用。 【英文摘要】:To summarize the experience of emergency liver transplantation for severe liver disease.METHODS:The clinic data of 27 cases of recipients who underwent emergency liver transplantation in our department, from January 2005 to October 2010, were retrospectively analyzed.RESULTS:Among the 27 patients,20 discharged after surgery, while 7 died during hospitalization. The hospital mortality of all recipients was 25.9%,6 months and 1 year survival rates were 74.1% and 70.4% respectively.4 cases of 5 ABO-incompatible liver transplantation recovered except that 1 patient died of MODS. All the 4 patients who were treated with artificial liver support system before operation went well.1 case of living donor liver transplantation recovered well, and has been alive for 27 months. Higher MELD score and serum creatinine level were found in the dead group during hospitalization, as compared to those in survival group (0.05 0.10); The survival rates also showed no significance between ABO-matched and ABO-incompatible group (P 0.10).CONCLUSIONS:1.For critically ill patients with liver disease, we should choose the appropriate recipients for emergency liver transplantation, to avoid the waste of valuable medical resources.2.Perioperative management should be strengthened to improve the success rate of surgery and recipient survival rates.3.ABO-incompatible liver transplantation and living donor liver transplantation in critically ill patients may s