论文部分内容阅读
目的 介绍近年来儿童活体肝移植术的进展。方法 以全球活体肝部分移植中心京都大学的资料为重点 ,综述近年来全球儿童活体肝移植术的现状。结果 活体肝移植仍然是儿童患者的首选术式 ,其主要适应证是胆汁淤积性肝病 (80 % ) ,全球最大一组资料 (4 62例 )表明 ,其 1、3、5年累计生存率分别为 79.8%、77.0 %和 77.0 % ,优于同期接受全肝移植的患者 (12 9例 ,1、3、5年累计生存率分别为 76.0 %、70 .0 %和 65 .0 % ) ,且择期手术患者的生存率 (85 .0 % )优于急诊手术者 (67.0 % ) ;死亡原因主要是排斥反应和感染。此外 ,对于儿童患者 ,还开展了原位辅助性活体肝部分移植和再次活体肝移植术。结论 严格选择手术适应证及手术时机和做好术后 1年内的管理是提高远期疗效的关键 ,儿童活体肝部分移植术疗效明显优于成人 ,也优于全肝移植术。
Objective To introduce the progress of living donor liver transplantation in recent years. Methods Based on the data from Kyoto University, a part of the global living donor liver transplantation center, the status of global living donor liver transplantation in recent years was reviewed. Results Living donor liver transplantation was still the first choice for pediatric patients. The main indication was cholestatic liver disease (80%). The world’s largest group of data (4262 cases) showed that the cumulative survival rates of 1, 3 and 5 years Were 79.8%, 77.0% and 77.0%, respectively, outperforming those who underwent total liver transplantation (129, 1,3 and 5 year cumulative survival rates were 76.0%, 70.0% and 65.0%, respectively) The survival rate of elective surgery patients (85.0%) was better than that of emergency surgery patients (67.0%). The causes of death were mainly rejection and infection. In addition, for pediatric patients, in situ assisted living partial liver transplantation and re-living liver transplantation have been conducted. Conclusion Strict selection of surgical indications and timing of surgery and management within one year after surgery is the key to improve long-term efficacy. Partial live donor liver partial grafting is superior to adults and better than total liver transplantation.