再次肝移植治疗慢性移植物功能衰竭4例报告及文献复习
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国家自然科学基金(81972768)


Report and research progress on liver retransplantation for chronic graft failure in 4 cases
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    目的:探讨针对慢性移植肝功能衰竭行再次肝移植治疗的经验。方法:回顾性分析2019年1月—2020年12月南京医科大学第一附属医院肝胆中心4例因慢性移植物衰竭行再次肝移植患者的手术时间、术中输血量、ICU住院时间、总住院时间、术后并发症等主要指标,同时行文献复习,总结再次肝移植的手术经验。结果:4例患者手术均取得成功,采用原位经典肝移植术式,平均手术时间为420 min(385~480 min),术中平均输注红细胞11.5 U(8~16 U)、新鲜冰冻血浆1 350 mL(1 000~2 075 mL),术后平均ICU住院时间3 d(2~4 d),术后平均住院时间21 d(14~31 d)。4例患者中3例住院期间无明显并发症出现。1例出现肝上下腔静脉吻合口狭窄,行经皮球囊扩张后治愈。出院后定期随访至今,3例病情均平稳,1例术后20个月死亡,死亡原因为非缺血性胆道病。结论:再次肝移植是治疗肝移植术后慢性移植物功能衰竭的唯一有效治疗手段。通过选择合适病例,改进手术技巧,提高围术期管理水平,有望取得较好疗效。

    Abstract:

    Objective:To explore the experience of liver re-transplantation for chronic graft failure. Methods:A retrospective analysis was conducted on 4 patients who underwent re-transplantation for chronic graft dysfunction in our team from January 2019 to December 2020,focusing on surgical time,intraoperative blood transfusion volume,ICU stay,total hospital stay,postoperative complications,and a literature review was conducted to summarize the experience of re-transplantation. Results:The surgery of all four patients were successful,using the in situ classic liver transplantation procedure,with an average operation time of 420 min(385-480 min),an average intraoperative infusion of 11.5 U of red blood cells(8-16 U),and an average of 1 350 mL of fresh frozen plasma (1 000-2 075 mL). The average ICU stay after surgery was 3 days(2-4 days),and an average postoperative hospitalization of hospital stay after surgery was 21 days(14-31 days). Among the 4 patients,3 had no significant complications during hospitalization. 1 patient developed stenosis of the inferior vena cava and was cured after percutaneous balloon dilation. Regular follow-up after discharge has shown stable conditions in 3 cases,while 1 patient died 20 months after surgery due to non-ischemic biliary disease. Conclusion:Liver re-transplantation is the only effective treatment for chronic graft failure after liver transplantation. By selecting suitable cases, improving surgical techniques,and enhancing perioperative management,better therapeutic effects are expected to be achieved.

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张龙,韩国勇,陈志强,张峰,吴金道.再次肝移植治疗慢性移植物功能衰竭4例报告及文献复习[J].南京医科大学学报(自然科学版),2024,(2):247-252

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  • 收稿日期:2023-10-20
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  • 在线发布日期: 2024-02-05
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