急性肝功能衰竭肝移植手术时机的探讨及预后分析

发表时间：2014-06-11 浏览次数：1099次

引用：

李彦杰.急性肝功能衰竭肝移植手术时机的探讨及预后分析[J].中华普通外科杂志.2013.28（3）：182-185

关键词：

肝移植，肝功能衰竭,急性，预后，手术时机

作者：

李彦杰，马毅，郭志勇，朱晓峰，何晓顺

作者单位：

510080广^州 ,中山大学附属第一医院器官移植屮心

出版年份：

2013

期刊页数：

182-185

收录者：

知网,万方

摘要：

目的：探讨急性肝功能衰竭患者行肝移植的手术时机及预后影响因素。方法回顾性分析屮山大学附属第一医院2005午3月至2010年6月收治的50例因急性肝功能衰竭行肝移植手术患者的临床资料。按手术效果分为预后良好组和预后不良组,总结术前临床及生化等指标分别行单因素及多因素分析,筛选与围手术期死亡相关的危险因素,指导手术时机的选择。结果50例行肝移植术的患者中,围手术期死亡11例 ,分别死于肺部感染5例、肾功能衰竭3例、原发性移植物无功能1例、消化道出血1例、多器官功能衰竭1例。围手术期、术后 1、3年生存存率分别为78%、74%、72%。单因素分析提示患者年龄、总胆红素、凝血酶原时间、INTR、肌酐、肝性脑病分期、MELD评分在预后良好组和预后不良组之问存在显著差异;多因素分析提示年龄≥65岁、 INR≥ 3.5、肌酐≥2.5ml、MELD≥40分是影响围手术期预后的独立危险因素。结论肝移植是治疗急性肝功能衰竭的有效办法,把握恰当的手术时机可使患者获得较高的生存率。 Objective To explore the optima1timing of liver transplantation fo acute liver failure, and analyze re1ative risk factors affecting patients’prognosis. Methods We retrospectively analyze perioperative clinical data of50patients suffering from acute liver failure who underwent liver transp1antation between l/Iarch2005 and Junc2010 in Organ Transplantation Center, the First Aff11iatcd Hospital of Sun Yat-sen University Patients were divided into survival group and death group Clinical data before operation were co11ected and analyzed by univariate and multivariate analysis, respeCtive1y Risk factors influencing the perioperative mortality were selected and were used to direct the operation time .Results There were 50 paticnts who underwent liver transplantation and11 cases died during perioperative phase .Five patients died of respiratory infection, three of acute renal fai1ure, one of digestive tract hemorrhage, one of primary allograft failure and one of mu1tiple organ failure The perioperative, one-year and three-year survival rate were78%,749% and729% respectively .In the univariate analysis, age, bi1irubin1evel, prothrombin time, creatinine level, grade of encephalopathy and MELD score Were found to be significantly different between survival group and death group. The multivariate ana1ysis revealed that age≥ 65 y, INR≥3 5, creatinine level≥2.5 mg/dl and MELD score≥40 were independent risk factors affecting survival. Conclusions Liver transplantation is an effective treatment of choice for acute liver failure Appropriate timing of transp1antation hclps achieve a high survival rate.

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