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目的探讨肝肾联合移植及其相关问题。方法对1例巨大的多囊肝、多囊肾患者和1例肝炎后肝硬化、肝癌合并肾功能衰竭患者实施一期肝肾联合移植。供体器官采用UW液原位灌注,快速切取。肝移植分别采用经典式或背驮式原位肝移植,肾移植采用常规方法。术后免疫抑制剂采用三联免疫方案。结果两例患者术后移植器官立即发挥功能。例1术后第2天发生急性肺损伤,第11天发生ARDS,经积极治疗后控制;例2肝、肾功能正常,未出现急性排斥反应和原发病复发等问题。结论肝肾联合移植是治疗肝肾终末期疾病的方法之一,完善的手术、严密的围手术期监测是肝肾联合移植成功的重要条件,肝肾联合移植手术可以取得良好的临床治疗效果,但在技术上较单纯的肝移植或肾移植要求更高、更复杂。
Objective To investigate the combined liver-kidney transplantation and its related problems. Methods One case of polycystic liver disease and polycystic kidney disease patients and one case of posthepatitic cirrhosis and liver cancer patients with renal failure were treated with combined liver and kidney transplantation. Donor organs in situ perfusion with UW solution, quickly cut. Liver transplantation using classic or piggyback orthotopic liver transplantation, kidney transplantation using conventional methods. Postoperative immunosuppressive agents using triple immunization programs. Results Two patients had immediate postoperative organ function. Example 1 Acute lung injury occurred on the second day after operation. ARDS occurred on the 11th day and was controlled after active treatment. Example 2 Hepatic and renal functions were normal with no acute rejection and recurrence of the primary disease. Conclusion Combined transplantation of liver and kidney is one of the methods for the treatment of end-stage liver and kidney disease. Perfecting surgery and strict perioperative monitoring are the important conditions for successful combined transplantation of liver and kidney. Combined liver and kidney transplantation can achieve good clinical therapeutic effect, However, it is technically more demanding and complicated than simple liver transplantation or kidney transplantation.