Uemoto S, Inomata Y, Tanaka K, Ozaki N, Egawa H, Okajima H, Nishizawa H, Yabe S, Yamaoka Y
Second Department of Surgery, Kyoto University Hospital, Japan.
Transpl Int. 1996;9 Suppl 1:S157-9. doi: 10.1007/978-3-662-00818-8_39.
Living related liver transplantation (LRLT) was performed in seven children with hypoxemia related to intrapulmonary shunting. Based on the degree of the shunt ratio calculated by technetium 99m macroaggregated albumin (MAA) scintigraphy, the seven patients were classified in the moderate (shunt ratio under 40%, n = 4) or severe group (shunt ratio over 40%, n = 3). While PaO2 was maintained over 60 mmHg in the moderate group, that in the severe group continued at a low level of under 40 mmHg in the early postoperative period. However, 48 h after surgery the arterial ketone body ratio recovered to a safe level of 1.0 in both groups. Values of aspartate aminotransferase and serum total bilirubin decreased at a constant rate in both groups. Six patients survived, but one died of portal vein thrombosis on the 53rd postoperative day. Five of six surviving patients recovered from hypoxemia. We concluded that the transplanted liver can tolerate the stress of severe hypoxemia after LRLT.
对7例因肺内分流导致低氧血症的儿童进行了活体亲属肝移植（LRLT）。根据通过锝99m大聚合白蛋白（MAA）闪烁扫描计算出的分流率，将这7例患者分为中度组（分流率低于40%，n = 4）或重度组（分流率高于40%，n = 3）。中度组的动脉血氧分压（PaO2）维持在60 mmHg以上，而重度组在术后早期持续处于40 mmHg以下的低水平。然而，术后48小时两组的动脉酮体比率均恢复到安全水平1.0。两组的天冬氨酸转氨酶和血清总胆红素值均以恒定速率下降。6例患者存活，但1例在术后第53天死于门静脉血栓形成。6例存活患者中有5例低氧血症恢复。我们得出结论，移植肝能够耐受活体亲属肝移植术后严重低氧血症的应激。
