公民逝世后器官捐献供肝移植31例临床效果分析
Clinical effect analysis of liver transplantation from donation after citizen's death in 31 cases
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摘要:目的 总结公民逝世后器官捐献供肝用于肝移植的临床经验及疗效分析。方法 回顾性分析2007年1月至2014年12月中国人民解放军第303医院收治的31例公民逝世后器官捐献肝移植病例的临床资料。结果 31例供体中符合中国标准Ⅰ类8例、Ⅱ类3例、Ⅲ类20例。按规范器官获取流程取得供肝。供肝的热缺血时间为2~13 min, 平均为9 min; 冷缺血时间为240~600 min, 平均为350 min。31例受体均顺利完成肝移植手术。其中29例受体恢复良好, 肝功能逐渐恢复, 未出现血栓形成、排斥反应, 4例出现胆道狭窄并发症, 经胆道支架置入术后引流通畅; 重症监护室(ICU)停留时间平均8 d, 术后住院时间平均21 d, 病情稳定后出院。受体总体存活率为81%, 1例术后2 d死于原发性肝脏无功能, 1例死于术后肺部感染, 4例肿瘤受者死于肿瘤复发转移。结论 公民逝世后器官捐献可以扩大供肝来源且近期效果良好。逐渐完善捐献供体器官功能保护措施, 严格掌握供者适应证、加强器官功能评估、缩短热冷缺血时间, 是改善临床效果的重要措施。Abstract:Objective To summarize the clinical experience and curative effect analysis of liver transplantation from donation after citizen's death.Methods Clinical data of 31 cases of liver transplantation from donation after citizen's death in the 303rd Hospital of People's Liberation Army were retrospectively studied.Results Among the 31 donors, 8 donors met ClassⅠof Chinese Standard, 3 met Class Ⅱ and 20 met Class Ⅲ. The liver graft was obtained according to the standardized organ procurement process. The warm ischemia time of the liver graft was 2-13 min with the average of 9 min and the cold ischemia time was 240-600 min with the average of 350 min. Thirty-one recipients underwent the liver transplantation successfully. Twenty-nine recipients recovered well and the liver function gradually recovered without thrombosis and rejection. Four recipients developed biliary stricture and the drainage was unobstructed after biliary stent placement. The average stay time in intensive care unit (ICU) was 8 d and the average length of stay after transplantation was 21 d. The recipients were discharged when the conditions were stable. The overall survival rate of the recipients was 81%. One recipient died of primary liver dysfunction at 2 d after transplantation, one recipient died of postoperative pulmonary infection and four tumor patients died of tumor recurrence and metastasis.Conclusions Donation after citizen's death may expand the source of liver grafts and the short term effect is good. To gradually improve function protective measures for donor organs, to strictly control indications of donors, to strengthen the assessment of organ function and to shorten warm and cold ischemia time are important measures to improve clinical effect.
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