Yamagishi Yoshiyuki, Saito Hidetsugu, Shimadu Motohide, Hoshino Ken, Kobayashi Hisashi, Nakamoto Nobuhiro, Horie Yoshinori, Kato Shinzo, Morikawa Yasuhide, Kitajima Masaki, Ishii Hiromasa
Department of Internal Medicine, School of Medicine, Keio University.
Nihon Shokakibyo Gakkai Zasshi. 2002 Oct;99(10):1205-12.
We followed up the patients with fulminant hepatic failure who admitted in our hospital and investigated clinical problems raised in the patients who underwent living-related liver transplantation (LRLT). Among 15 patients with fulminant hepatic failure 6 were managed without LRLT and 3 patients survived, and the survival rate was 50%. Other 9 patients received LRLT, and 2 of these 9 died with their complications after the transplantation. Thus the survival rate by LRLT in fulminant hepatic failure was 77.8%. Brain CT scan examination showed severe brain edema in a patient and the edema did not improve after LRLT. Another patient suffered from development of fungal infection in her lungs after LRLT. We suspected the presence of subclinical infection in the preoperation period. The recovery from brain edema and the existence of subclinical infection are mostly difficult to evaluate but are very important for obtaining a good output. These results suggest that LRLT is a promising procedure for treatment of fulminant hepatic failure but a close cooperation between physicians of internal medicine and transplantation surgery from preoperative management until postoperative period is necessary.
我们对我院收治的暴发性肝衰竭患者进行了随访，并调查了接受活体肝移植（LRLT）患者出现的临床问题。在15例暴发性肝衰竭患者中，6例未接受LRLT治疗，3例存活，存活率为50%。另外9例患者接受了LRLT，其中2例在移植后因并发症死亡。因此，暴发性肝衰竭患者接受LRLT后的存活率为77.8%。脑部CT扫描检查显示1例患者有严重脑水肿，LRLT后水肿未改善。另1例患者在LRLT后肺部发生真菌感染。我们怀疑术前存在亚临床感染。脑水肿的恢复和亚临床感染的存在大多难以评估，但对获得良好疗效非常重要。这些结果表明，LRLT是治疗暴发性肝衰竭的一种有前景的方法，但从术前管理到术后阶段，内科医生和移植外科医生之间的密切合作是必要的。
