同期肝肾联合移植：单中心经验分析。

Organ Transplantation Center, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China.

Chin Med J (Engl). 2010 May 20;123(10):1259-63.

BACKGROUND

Simultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT.

METHODS

The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed.

RESULTS

All operations were successfully performed. Postoperative complications occurred in 13 cases (59.1%), including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinal bleeding (1), and acute liver graft rejection (1). All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively.

CONCLUSIONS

SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve the long-term patient survival after SLKT.

背景

肝、肾联合移植（SLKT）已被证实是治疗合并终末期肝、肾功能衰竭的有效方法。然而，接受 SLKT 的患者往往具有较长的病史、较差的一般情况，常伴有贫血、低蛋白血症、凝血功能障碍、水-电解质失衡和酸碱紊乱。本研究旨在探讨 SLKT 的适应证、手术技术、治疗经验、术后并发症的预防和治疗。

方法

回顾性分析中山大学附属第一医院 2001 年 1 月至 2008 年 12 月期间施行的 22 例 SLKT 患者的临床资料。分析 SLKT 的适应证、手术技术、围手术期液体管理、免疫抑制方案及术后并发症的预防和治疗经验。

结果

所有手术均顺利完成。术后并发症 13 例（59.1%），包括胸腔积液 7 例，腹腔内出血 2 例，胆漏 2 例，上消化道再出血 1 例，急性肝移植排斥反应 1 例。所有并发症均经保守治疗治愈。随访期间死亡 5 例，其中 3 例围手术期死亡，均因原发病重。3 个月死亡率为 13.6%。1 年和 3 年患者生存率分别为 81.3%和 73.9%。

结论

SLKT 是治疗终末期肝病合并慢性肾衰竭或严重肾功能损害的有效方法。它是一种复杂的手术，会引起循环和液体平衡的较大紊乱，并导致更多的术后并发症。SLKT 手术技术的选择取决于外科医生的经验、受者解剖和原发疾病。正确的围手术期液体管理、合理的免疫抑制方案、预防和治疗术后感染对于提高 SLKT 后患者的长期生存率至关重要。