Ｏｕｒ ｔｅｃｈｎｉｑｕｅ ｆｏｒ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｗａｓ ｂａｓｅｄ ｏｎ ｔｈｅ ｔｅｃｈｎｉｑｕｅ ｄｅｓｃｒｉｂｅｄ ｂｙ Ｈｅｓｓ ｗｉｔｈ ｔｈｅ ｅｘｃｅｐｔｉｏｎ ｏｆ ｔｈｅ ｌｅｎｇｔｈ ｏｆ ｔｈｅ ｃｕｆｆ ｏｆ ｔｈｅ ｇｒａｆｔ ｖｅｎａ ｃａｖａ ａｎｄ ｅｓｔａｂｌｉｓｈｍｅｎｔ ｏｆ ｔｈｅ ｐｏｒｔａｌ ｖｅｉｎ ａｎａｓｔｏｍｏｓｉｓ．Ａ ｔｏｔａｌ ｏｆ ６０ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ，ｏｆ ｗｈｉｃｈ ２４ ｗｅｒｅ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎ．Ｉｎ ｔｈｅ ５ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎｓ ｔｈｅ ｇｒａｆｔｓ ｓｕｒｖｉｖａｌ ａｓｓｅｓｓｅｄ ｂｙ ９７ｍＴｃｓｏｄｉｕｍ ｐｈｙｔａｔｅ ｄｅｍｏｎｓｔｒａｔｅｄ ａ １ｗｅｅｋ ｓｕｒｖｉｖａｌ ｏｆ １００％．Ｈｏｗ ｔｏ ｒｅｄｕｃｅ ｔｈｅ ｃｏｍｐｌｉｃａｔｉｏｎｓ ｉｎ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｉｎ ｒａｔｓ ｉｓ ｄｉｓｃｕｓｓｅｄ ｉｎ ｔｈｅ ａｒｔｉｃｌｅ．
Objective To observe the effects of Thymosin α1 （Tα1） on acute rejection after liver transplantation and immune function of T cells. Methods Twenty recipients of liver transplantation due to primary hepatic carcinoma were divided into two groups: Tα1 group (n=10) and control group (n=10). Tα1 group received subcutaneous injection of Tα1 1.6 mg on the first day after liver transplantation and then twice a week for at least one month. Both Tα1 group and control group took same immunodepressants. Core biopsies were carried to compare the incidence rate of acute rejection between Tα1 group and control group. Peripheral T cellular immune function in these two groups was detected on 1 d before, 1 week, 2 weeks and 1 month after transplantation. Results There was not significant difference of incidence rate of acute rejection between Tα1 group and control group (Pgt;0.05). In the Tα1 group, CD4+, CD8+ lymphocyte cell counts and the CD4+/CD8+ ratio were significantly higher than those in the control group in 2 weeks and 1 month after transplantation (P＜0.05). Conclusion Use of Tα1 in recipients who also takes rountine immunosuppressants dose not increase the risk of occurring acute rejection after liver transplantation. Tα1 can significantly increase CD4+, CD8+ counts and CD4+/CD8+ ratio, which shows that Tα1 may improve recipients’ cellular immune function.
Objective To review the advances of livingrelated liver transplantation for children. MethodsOn the basis of the data in Kyoto university, the center of livingrelated liver transplantation in the world, the current situation of livingrelated liver transplantation for children were investigated. ResultsEighty percent of patients who underwent the livingrelated liver transplantation were children with cholestatic liver disease. From the data of 462 cases, the patients’survival rate for 1, 3 and 5 years after livingrelated liver transplantation (79.8%, 77.0% and 77.0% respectively) preceded the survival rate of 129 patients who underwent the whole liver transplantation (76.0%, 70.0% and 65.0% respectively). To the livingrelated liver transplantation, the survival rate was higher for patients who underwent selective operation (85.0%) than emergency surgery (67.0%). The principal causes of death were rejection and infection. Furthermore, a partial orthotopic liver transplantation and livingrelated liver replantation were performed for children. Conclusion Strict indication, optimal health status and perfect postoperative management are the keys to keep patients longterm healthy survival. The curative effect of livingrelated liver transplantation precedes the whole liver transplantation. For children, livingrelated liver transplantation is better than for adults.
目的：探討毒蕈中毒所致中毒性肝炎的臨床表現、治療與預后關系。方法：對3例急性毒蕈中毒患者進行回顧性臨床分析。結果：3例患者均出現中毒性肝炎，2例經治療后好轉，1例因多器官功能衰竭死亡。結論：中毒性肝炎如導致多臟器損害，預后差；及早洗胃，徹底清除毒物是救治關鍵；血漿置換治療有一定療效，肝移植是最有效的治療手段。
Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases. Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure. Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH), and 10＜pressure≤15 cm H2O as gradeⅠ, 15＜pressure≤25 cm H2O as grade Ⅱ, 25＜pressure≤35 cm H2O as grade Ⅲ, over 35 cm H2O as grade Ⅳ. The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were recorded to every patient, and the parameters of each grade IAH group were contrasted with non-IAH group. ResultsAmong 143 cases, 45 cases were IAH (31.5%), in which 18 cases belonged to grade Ⅰ, 13 cases belonged to grade Ⅱ, 11 cases belonged to grade Ⅲ, while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased (P＜0.05, P＜0.01), PaO2 significantly decreased (P＜0.05, P＜0.01) in each grade IAH group; Respiratory frequency (RF), heart rate (HR) and PaCO2 significantly increased (P＜0.05, P＜0.01) in some grade IAH group (HR in grade Ⅱ, Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ). Conclusions Intra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.
通過對1999年1月至2007年8月，肝移植病人術后門診復查的情況做一總結，通過護理干預，使病人復查得到極大方便，并拓展了護理工作領域，提高了門診護理工作的質量，并提升了醫院的形象。
【Abstract】 Objective To report 1 case of acute hemolytic anemia after liver transplantation because of ABO compatibility and therapeutic experience. Methods The patient with liver cancer underwent orthotopic piggyback liver transplantation on September 2010 after radiofrequency ablation of the tumors. The donor and recipient ABO blood types were type O and type A, separately. Acute hemolytic anemia occurred at 10 days after transplantation and hemoglobin decreased to 56 g/L. The bone marrow showed active hyperplasia; and myeboid∶erythroid was 0.52∶1. The immunosuppressants were used and type O washed red blood cells were transfused immediately. Results The general condition of the patient was improved; hemoglobin increased gradually and returned to 111 g/L at 34 days after liver transplantation. At 12 months of follow-up, hemoglobin was within normal range. Conclusion Using graft blood type washed red blood cells transfusion and immunosuppressants could be an effective therapeutic procedure in the patient with ABO compatility graft when acute hemolytic anemia occurrs.