公民逝世后器官捐献肝移植78例临床经验分析

摘要

目的：总结公民逝世后器官捐献肝移植的临床经验及疗效分析。方法回顾性分析2012年3月至2015年11月四川大学华西医院肝脏移植中心完成的公民逝世后器官捐献供体肝移植的76例供体和78例受体的临床资料。观察肝移植受体早期移植物功能恢复情况并分析引起早期移植物功能障碍（EAD）的危险因素，观察远期的移植物生存及受体生存情况、并发症发生情况。结果78例受体术后 EAD 的发生率为36％（28／78），其中供体总胆红素（TB）高和冷缺血时间长是 EAD 发生的危险因素。受者围手术期存活率为92％（72／78），死亡6例，分别死于原发性移植物失功4例、上消化道大出血1例、肺部感染1例。术后发生腹腔感染5例，胆道狭窄3例，血管血栓形成2例，除1例死亡外，其余经相应治疗后好转。受体术后1年的存活率为84.2％，2年存活率为80.0％。结论公民逝世后器官捐献供肝是较好的供肝来源，其近远期效果良好。控制术前供肝质量，缩短冷缺血时间等均是提高临床效果的重要措施。%Objective To summarize the clinical experience and effect analysis of liver transplantation from donation after citizen’s death. Methods Clinical data of 76 donors and 78 recipients of liver transplantation from donation after citizen’s death completed in Liver Transplantation Center of West China Hospital,Sichuan University from March 2012 to November 2015 were analyzed retrospectively.The functional recovery of early allografts in liver transplant recipients was observed and the risk factors causing early allograft dysfunction (EAD)were analyzed.In addition,long﹣term survival of allografts and recipient as well as complications was observed. Results The incidence of postoperative EAD was 36%(28 /78)in 78 recipients.High total bilirubin (TB)and long cold ischemia time constituted the risk factors of EAD. Survival rate of the recipients was 92% (72 /78)during perioperation,and 6 cases died,of which 4 cases died of primary graft dysfunction,1 case of upper gastrointestinal hemorrhage and 1 case of pulmonary infection.Postoperative abdominal infection occurred in 5 cases,with biliary stricture in 3 cases and vascular thrombosis in 2 cases.One case died,and the rest were improved after corresponding treatment.The 1﹣year survival rate of the recipients was 84.2% and 2﹣year survival rate was 80% after operation. Conclusions Liver transplantation from donation after citizen’s death realizes favorable short and long﹣term effects,which can be regarded as a good source of donor livers.Important measures such as controlling the preoperative quality of donor liver and shortening the cold ischemia time can improve the clinical effect.