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中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 397 -400. doi: 10.3877/cma.j.issn.2095-3232.2017.05.014

所属专题: 文献

临床研究

肝移植术在原发性胆汁性肝硬化中的应用价值
苗润晨1, 曲凯1, 李泽雨1, 毕建斌1, 顾静娴1, 刘昌1,()   
  1. 1. 710061 西安交通大学医学院第一附属医院肝胆外科
  • 收稿日期:2017-06-28 出版日期:2017-10-10
  • 通信作者: 刘昌

Application value of liver transplantation for primary biliary cirrhosis

Runchen Miao1, Kai Qu1, Zeyu Li1, Jianbin Bi1, Jingxian Gu1, Chang Liu1,()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University Medical College, Xi'an 710061, China
  • Received:2017-06-28 Published:2017-10-10
  • Corresponding author: Chang Liu
  • About author:
    Corresponding author: Liu Chang, Email:
引用本文:

苗润晨, 曲凯, 李泽雨, 毕建斌, 顾静娴, 刘昌. 肝移植术在原发性胆汁性肝硬化中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2017, 06(05): 397-400.

Runchen Miao, Kai Qu, Zeyu Li, Jianbin Bi, Jingxian Gu, Chang Liu. Application value of liver transplantation for primary biliary cirrhosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(05): 397-400.

目的

探讨肝移植术在原发性胆汁性肝硬化(PBC)治疗中的应用价值。

方法

回顾性分析2006年7月至2016年11月在西安交通大学第一附属医院行肝移植术的16例PBC患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男4例,女12例;平均年龄(54±6)岁。所有患者均采用同种异体改良背驮式原位肝移植术。观察患者的基本资料、临床症状、体征以及实验室检查、肝移植术中及术后情况,且术后对患者进行定期随访。

结果

患者术前有不同程度的肝功能异常和黄疸。在接受原位肝移植术过程中,1例患者死于失血性休克;其余15例患者均成功手术,手术时间(378±67)min,无肝期时间(37±7)min,术中出血量(2 389±1 319)ml,术后未出现手术并发症,术后住院时间中位数21(9~56)d。2例患者分别于术后40、60 d出现中度急性排斥反应,经加强免疫抑制治疗后肝功能逐渐恢复至正常;其中1例出现应激性溃疡,给予制酸剂及减少激素用量后患者情况恢复正常;另1例患者急性排斥反应恢复后出现急性胆管炎,肝移植术后2年进行二次肝移植。随访期间2例失访;3例死亡,其中2例分别于术后32 d和97 d死于脓毒血症引起的多器官功能衰竭,1例于术后2年死于呼吸系统相关并发症。

结论

肝移植术为目前治疗PBC最有效的手段,积极的术前评估和处理及严格的手术操作是手术成功的关键,而术后免疫抑制剂及其他辅助药物的合理应用是避免PBC复发的有效措施。

Objective

To investigate the application value of liver transplantation (LT) in the treatment of primary biliary cirrhosis (PBC).

Methods

Clinical data of 16 patients with PBC who underwent LT in the First Affiliated Hospital of Xi'an Jiaotong University Medical College between July 2006 and November 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 4 cases were males and 12 females, aged (54±6) years old on average. Allogeneic modified piggyback orthotopic LT was performed in all patients. The general data, clinical symptoms, physical signs, laboratory test, intraoperative and postoperative conditions were observed. All patients received postoperative follow-up on a regular basis.

Results

Varying degrees of liver dysfunction and jaundice were observed in the patients before LT. Intraoperatively, 1 patient died from hemorrhagic shock and the remaining 15 cases successfully completed the surgery. The operation time was (378±67) min, the anhepatic phase time was (37±7) min, and the intraoperative blood loss was (2 389±1 319) ml. No postoperative surgical complications were observed. The median postoperative length of hospital stay was 21(9-56) d. Moderate degree of acute rejection was respectively observed at postoperative 40 and 60 d in 2 patients, and the liver function was gradually restored to normal after the immunosuppressive therapy was strengthened. Among the 2 patients, 1 case suffered from stress ulcer and was cured after administration of antiacid and decreasing the dosage of hormone, the other case suffered from acute cholangitis after the restoration of acute rejection, and underwent secondary LT at postoperative 2 years. During the follow-up, 2 cases lost to follow-up and 3 died. Among the 3 patients, 2 died from multiple organ failure induced by septicopyemia at postoperative 32 and 97 d, and 1 died from respiratory system-related complications at postoperative 2 years.

Conclusions

LT is the most effective treatment for PBC at present. Active preoperative evaluation and processing, and strict surgical procedures are the keys to the success of surgery. Rational postoperative administration of immunosuppressive agents and other adjuvant drugs can effectively prevent the recurrence of PBC.

[1]
Carey EJ, Ali AH, Lindor KD. Primary biliary cirrhosis[J]. Lancet, 2015, 386(10003):1565-1575.
[2]
Webb GJ, Siminovitch KA, Hirschfield GM. The immunogenetics of primary biliary cirrhosis: a comprehensive review[J]. J Autoimmun, 2015, 64:42-52.
[3]
Singal AK, Fang X, Kaif M, et al. Primary biliary cirrhosis has high wait-list mortality among patients listed for liver transplantation[J]. Transpl Int, 2017, 30(5):454-462.
[4]
Weinmann A, Sattler T, Unold HP, et al. Predictive scores in primary biliary cirrhosis: a retrospective single center analysis of 204 patients[J]. J Clin Gastroenterol, 2015, 49(5):438-447.
[5]
Parés A. Old and novel therapies for primary biliary cirrhosis[J]. Semin Liver Dis, 2014, 34(3):341-351.
[6]
Floreani A, Tanaka A, Bowlus C, et al. Geoepidemiology and changing mortality in primary biliary cholangitis[J]. J Gastroenterol, 2017, 52(6):655-662.
[7]
Chascsa D, Carey EJ, Lindor KD. Old and new treatments for primary biliary cholangitis[J]. Liver Int, 2017, 37(4):490-499.
[8]
Hirschfield GM, Mason A, Luketic V, et al. Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid[J]. Gastroenterology, 2015, 148(4): 751-761, e8.
[9]
Trivedi PJ, Hirschfield GM, Gershwin ME. Obeticholic acid for the treatment of primary biliary cirrhosis[J]. Expert Rev Clin Pharmacol, 2016, 9(1):13-26.
[10]
Tanaka A, Ma X, Yokosuka O, et al. Autoimmune liver diseases in the Asia-Pacific region: proceedings of APASL symposium on AIH and PBC 2016[J]. Hepatol Int, 2016, 10(6):909-915.
[11]
Corpechot C. Primary biliary cirrhosis beyond ursodeoxycholic acid[J]. Semin Liver Dis, 2016, 36(1):15-26.
[12]
Czul F, Levy C. Novel therapies on primary biliary cirrhosis[J]. Clin Liver Dis, 2016, 20(1):113-130.
[13]
Yang H, Duan Z. Bile acids and the potential role in primary biliary cirrhosis[J]. Digestion, 2016, 94(3):145-153.
[14]
Zhu GQ, Shi KQ, Huang S, et al. Network meta-analysis of randomized controlled trials: efficacy and safety of UDCA-based therapies in primary biliary cirrhosis[J]. Medicine, 2015, 94(11): e609.
[15]
Dyson JK, Wilkinson N, Jopson L, et al. The inter-relationship of symptom severity and quality of life in 2 055 patients with primary biliary cholangitis[J]. Aliment Pharmacol Ther, 2016, 44(10):1039-1050.
[16]
Raczyńska J, Habior A, Pączek L, et al. Primary biliary cirrhosis in the era of liver transplantation[J]. Ann Transplant, 2014, 19:488-493.
[17]
Hosonuma K, Sato K, Yamazaki Y, et al. A prospective randomized controlled study of long-term combination therapy using ursodeoxycholic acid and bezafibrate in patients with primary biliary cirrhosis and dyslipidemia[J]. Am J Gastroenterol, 2015, 110(3): 423-431.
[18]
Gilroy RK, Lynch SV, Strong RW, et al. Confirmation of the role of the Mayo Risk Score as a predictor of resource utilization after orthotopic liver transplantation for primary biliary cirrhosis[J]. Liver Transpl, 2000, 6(6):749-752.
[19]
Žampachová V, Honsová E. Recurrence of primary diseases after liver transplantation[J]. Cesk Patol, 2015, 51(4):170-174.
[20]
Egawa H, Nakanuma Y, Maehara Y, et al. Disease recurrence plays a minor role as a cause for retransplantation after living-donor liver transplantation for primary biliary cirrhosis: a multicenter study in Japan[J]. Hepatol Res, 2013, 43(5):502-507.
[21]
Shiba H, Wakiyama S, Futagawa Y, et al. Switching from tacrolimus to cyclosporine A to prevent primary biliary cirrhosis recurrence after living-donor liver transplantation[J]. Int Surg, 2013, 98(2):156-159.
[22]
Bosch A, Dumortier J, Maucort-Boulch D, et al. Preventive administration of UDCA after liver transplantation for primary biliary cirrhosis is associated with a lower risk of disease recurrence[J]. J Hepatol, 2015, 63(6):1449-1458.
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