目的 總結肝移植治療慢性重癥肝炎急性肝衰竭的經驗，以期改善預后。 方法 回顧性分析我院施行的3例慢性重癥肝炎急性肝衰竭肝移植臨床資料。結果 2例男性，1例女性，術前均診斷為慢性重癥肝炎急性肝衰竭，肝功能Child分級均為C級，MELD評分分別為56.72、31.90及52.83，肝性腦病Ⅱ°～Ⅳ°，均合并肺部、腹腔感染，術前人工肝治療1～3次，均行背馱式肝移植，術后病例3停用免疫抑制劑11 d，病例2和病例3痊愈出院，病例1因嚴重感染繼發多器官功能衰竭死亡。結論 術前、術后人工肝支持改善內環境、術中及時補充凝血物質和術后有效控制感染是保證肝移植治療慢性重癥肝炎急性肝衰竭良好預后的關鍵措施。
ObjectiveTo evaluate the operative technique and clinical efficacy of laparoscopic splenectomy (LS) combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis. MethodsTwelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010, which clinical data were analyzed and summarized retrospectively. ResultsThe splenic artery was ligated before the treatment of splenic pedicle in 12 cases, LS combined with pericardial devascularization was successfully performed in 10 cases, 7 cases of which were treated by the level two transection method of splenic pedicle, and 2 cases were converted to open surgery due to intraoperative bleeding. In 10 cases, the operative time was 180-300 min (average 210 min), and intraoperative blood loss was 200-1 000 ml (average 480 ml). The postoperative hospital stay was 8-15 d (average 9 d)， the postoperative complications included plural effusion （lt;300 ml） in 2 cases， mild ascites （lt;300 ml） in 2 cases, and mild pancreatic leakage in 1 case， but all were cured eventually， and no mortality occurred. Followup was conducted in 12 patients for 4 to 20 months (average 7 months), and no rebleeding occurred. ConclusionsLS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis. The keys to success include ligation of splenic artery, and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.