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《中华消化外科杂志》2019年4月第18卷第4期论著

腔静脉-心房吻合肝移植治疗布加综合征的临床疗效

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引用本文:
叶啟发12,明英姿2,宫念樵3,等.腔静脉-心房吻合肝移植治疗布加综合征的临床疗效[J].中华消化外科杂志,2019,18(4):342-347.DOI:10.3760/cma.j.issn.1673-9752.2019.04.009.
【摘要】

目的:探讨腔静脉心房吻合肝移植(VCAALT)治疗布加综合征(BCS)的临床疗效。
方法:采用回顾性描述性研究方法。收集1996年5月至2012年12月武汉大学中南医院(6例)、中南大学湘雅三医院(8例)和华中科技大学同济医学院附属同济医院(4例)收治的18例行VCAALT治疗BCS患者的临床病理资料;患者均为男性;平均年龄为42岁,年龄范围为29~61岁。18例患者完善术前相关检查后,根据BCS患者肝静脉与腔静脉病变特点及其侵犯范围,选择不同VCAALT手术方式,包括桥式背驮式肝移植 (BPBLT)、心房悬吊式肝移植(HALT)、腔静脉切除桥式肝移植(CVRBLT)。观察指标:(1)手术及术后情况。(2)典型病例分析。(3)随访情况。采用门诊和电话方式进行随访,了解患者术后生存情况。随访时间截至2018年12月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示。
结果:(1)手术及术后情况:18例患者中,11例行BPBLT,3例行HALT,4例行CVRBLT。18例患者手术时间为(6.0±1.3)h,术中出血量为(1 264±435)mL。1例患者术后因严重感染死于双肺弥漫性炎症和败血症。18例患者术后住院时间为(18±5)d。(2)典型病例分析:1例47岁男性BCS患者开腹探查肝后腔静脉有斑块和血栓、肝静脉内血栓,选择行BPBLT;1例43岁男性BCS患者探查肝脏及肝后腔静脉触及斑块并见陈旧血栓、腔静脉旁海绵样变,选择行HALT;1例32岁男性BCS患者探查肝静脉、右肾静脉至右心房段均为斑块与血栓,并见红血栓,选择行CVRBLT。3例患者均成功行VCAALT,术后恢复良好。(3)随访情况:18例患者均获得术后随访,随访时间为3.0~60.0个月,中位随访时间为51.7个月。随访期间,3例患者分别于术后1、3、5年死于急性排斥反应、胆道并发症、移植物慢性功能丧失。18例患者术后1、3、5年生存率分别为 16/18、15/18、14/18。
结论:根据患者不同情况选择不同VCAALT手术方式治疗BCS安全可行,疗效较好,有利于患者长期生存。

【Abstract】

Objective:To investigate the clinical efficacy of vena cava-atrium anastomosis liver transplantation (VCAALT) for BuddChiari syndrome (BCS).
Methods:The retrospective descriptive study was conducted. The clinicopathological data of 18 BCS patients who underwent VCAALT in the Zhongnan Hospital of Wuhan University (6 cases), the Third Xiangya Hospital of Central South University (8 cases) and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (4 cases) from May 1996 to December 2012 were collected. All the 18 patients were males, aged from 29 to 61 years, with an average age of 42 years. According to characteristics and invasion extent of hepatic vein and vena cava after preoperative examinations, patients were performed different surgical procedures of VCAALT, including bridge piggyback liver transplantation (BPBLT) , hanging atrium liver transplantation (HALT) and cava vena resection bridge liver transplantation (CVRBLT). Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) followup situations. Followup using outpatient examination and telephone interview was performed to detect patients′ survival up to December 2018. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were described as M (range).
Results: (1) Surgical and postoperative situations: of 18 patients, 11 underwent BPBLT, 3 underwent HALT, 4 underwent CVRBLT. The operation time and volume of intraoperative blood loss were (6.0±1.3)hours and (1 264±435)mL. One patient died of bilateral pulmonary diffuse inflammation and sepsis due to severe infection. The duration of postoperative hospital stay was (18±5)days. (2) Typical case analysis: one 47-year-old male BCS patient was detected retrohepatic vena cava plaques and thrombus and hepatic venous thrombus by exploratory laparotomy, and underwent BPBLT. A 43-year-old male BCS patient was detected hepatic and retrohepatic vena cava plaques, thrombus, concomitant cavernous transformation, and underwent HALT. A 32-yea-rold male BCS patient was detected plaques and thrombus with red thrombus in the hepatic vein, from right renal vein to right atrium, and underwent CVRBLT. All the 3 patients underwent VCAALT successfully with a satisfactory recovery. (3) Follow-up situations: 18 patients were followed-up for 3.0-60.0 months, with a median time of 51.7 months. During the follow-up, 3 patients died of acute rejection, biliary complications and chronic graft dysfunction at 1, 3, 5-years postoperatively. The 1, 3, 5-year survival rates were 16/18, 15/18, 14/18, respectively.
Conclusion:Different surgical procedures of VCAALT for BCS are selected according to different situations of patients, which are safe and feasible with a satisfactory efficacy and beneficial to long-term survival of patients.

DOI:10.3760/cma.j.issn.1673-9752.2019.04.009
基金项目:国家自然科学基金新疆联合基金重点项目(U1403222);湖北省自然科学基金项目(2016CFA094)
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