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摘要:
目的 探讨肝移植手术治疗危重症肝病的临床疗效。 方法 回顾性分析接受肝移植治疗的51例危重症肝病患者的临床资料。观察患者术中的一般情况，包括手术时间、热缺血时间、冷缺血时间、无肝期、出血量、输血量、输血浆量等指标；观察术前及术后3 d、1周及2周患者总胆红素（TB）、凝血酶原活动度（PTA）、凝血酶原时间国际标准化比值（PT-INR）等指标的变化情况；分析受者的术后生存情况及并发症发生情况；对可能影响危重症肝病患者预后的指标进行Cox回归分析。 结果 51例患者的手术时间为8（7, 9）h，供肝热缺血时间为3（2, 3）min，冷缺血时间为6（5, 8）h，术中无肝期为80（70, 100）min，术中出血量为1 000（550, 1 500）mL，术中输血量为1 200（200，1 600）mL。术后TB、PTA、PT-INR等指标较术前明显改善。51例患者中，10例死亡，死亡原因分别为多器官功能衰竭及严重感染7例、肾功能不全2例、心血管并发症1例。危重症肝病患者移植术后1个月和1年的生存率分别为82%和80%。Cox回归分析提示术前PTA、PT-INR异常是危重症肝病患者肝移植术后死亡的危险因素。 结论 肝移植能够显著提高危重症肝病患者的生存率，加强围手术期感染的防治和多器官功能管理是提高危重症肝病患者移植术后生存率的关键措施。 Abstract:Objective To explore the clinical efficacy of liver transplantation for severe liver disease. Methods The clinical data of 51 patients who underwent liver transplantation for severe liver disease were retrospectively analyzed. The general intraoperative conditions were observed, including operation duration, warm ischemia time, cold ischemia time, anhepatic phase, bleeding volume, blood transfusion volume, plasma transfusion volume and so on. The changes in indexes such as total bilirubin (TB), prothrombin time activity (PTA), and prothrombin time international normalized ratio (PT-INR) were observed before operation and at 3 d, 1 week and 2 weeks after operation. The postoperative survival and occurrence of complications were analyzed. The indexes that might affect the prognosis of patients with severe liver disease were analyzed by Cox regression analysis. Results For the 51 patients, operation duration, warm ischemia time and cold ischemia time was 8 (7, 9) h, 3 (2, 3) min and 6 (5, 8) h respectively, intraoperative anhepatic phase was 80 (70, 100) min, intraoperative bleeding volume was 1 000 (550, 1 500) mL, and intraoperative blood transfusion volume was 1 200 (200, 1 600) mL. Postoperative TB, PTA, PT-INR and other indexes improved significantly compared to those preoperatively. Among the 51 patients, 10 cases died, with the death causes of multiple organ failure and severe infection(7 cases), renal insufficiency (2 cases), and cardiovascular complications (1 case). Survival rates at 1 month and 1 year post-transplantation for patients with severe liver disease were 82% and 80%, respectively. Cox regression analysis suggested that abnormal preoperative PTA and PT-INR were the risk factors for post-transplantation death in patients with severe liver disease. Conclusions Liver transplantation significantly improves the survival rate for patients with severe liver disease, perioperative infection prevention and treatment as well as multiple organ function management play key roles in improving post-transplantation survival rate in patients with severe liver disease. -
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