• 浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院肝膽胰診治中心 (浙江杭州 310003);

目的  探討肝臟移植治療門靜脈高壓癥所致上消化道出血的可行性及安全性,并與傳統(tǒng)手術(shù)的療效進(jìn)行比較。
方法  回顧性分析2009年2月至2012年2月期間浙江大學(xué)附屬第一醫(yī)院肝膽胰診治中心收治的303例門靜脈高壓癥合并上消化道出血患者的臨床資料。其中101例患者接受肝移植治療(肝移植組),202例患者接受常規(guī)手術(shù)治療(常規(guī)手術(shù)組),術(shù)后隨訪8~44個(gè)月,平均26個(gè)月。
結(jié)果  常規(guī)手術(shù)組患者術(shù)前肝功能明顯優(yōu)于肝移植組(P<0.01),2組患者總體死亡率比較差異無(wú)統(tǒng)計(jì)學(xué)意義〔7.4%(14/189) 比 3.0%(3/101),P=1.00〕。肝移植組術(shù)后再出血率為2.0%(2/101),低于常規(guī)手術(shù)組的9.5%(18/189),P< 0.05。肝移植組術(shù)后內(nèi)鏡下曲張靜脈消失率為86.1%(87/101),高于常規(guī)手術(shù)組的54.5%(86/189),P< 0.01。
結(jié)論  肝移植治療門靜脈高壓癥所致上消化道出血是安全可靠的。有出血史但術(shù)前肝功能尚好的患者,接受常規(guī)手術(shù)后能維持較好的肝臟功能和生活質(zhì)量。終末期肝病門靜脈高壓癥患者,肝移植是唯一的治愈方案。

引用本文: 俞軍,張武,張珉,王偉林,周琳,沈巖,湯灑瀟,程龍宇,謝尚奮,陳智贇,鄭樹森. 肝移植治療門靜脈高壓上消化道出血的療效分析△. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(1): 24-28. doi: 復(fù)制

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2. Gines P, Cardenas A, Arroyo V, et al. Management of cirrhosis and ascites[J]. N Engl J Med, 2004, 35(916): 1646-1654.
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9. Carbonell N, Pauwels A, Serfaty L, et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades[J]. Hepatology, 2004, 40(3): 652-659.
10. Starzl TE, Marchioro TL, Vonkaulla KN, et al. Homotransplantation of the liver in humans[J]. Surg Gynecol Obstet, 1963, 117: 659-676.
11. Starzl TE, Fung JJ. Themes of liver transplantation[J]. Hepatology, 2010, 51(6): 1869-1884.
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19. Klupp J, Kohler S, Pascher A, et al. Liver transplantation as ultimate tool to treat portal hypertension[J] . Dig Dis, 2005, 23(1):65-71.
20. Henderson JM, Yang Y. Is there still a role for surgery in bleeding portal hypertension?[J]. Nat Clin Pract Gastroenterol Hepatol, 2005,2(6): 246-247.
21. 嚴(yán)律南. 肝硬變門脈高壓癥的肝臟移植經(jīng)驗(yàn)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2001, 19(9): 951-956.
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23. Waiting time to transplant[DB/OL]. http://www. organdonation. nhs. uk. (accessed on 1 NoV. 2012).
24. de Franchis R, Dell’Era A, Iannuzzi F. Diagnosis and treatment of portal hypertension[J]. Dig Liver Dis, 2004, 36(12): 787-798.
25. Bismuth H, Adam R, Raccuia JS. 肝臟移植治療門脈高壓癥[J]. 德國(guó)醫(yī)學(xué), 1996, 13(3): 157-159.
  1. 1. Dong MH, Saab S. Complications of cirrhosis[J]. Dis Mon, 2008, 54(7): 445-456.
  2. 2. Gines P, Cardenas A, Arroyo V, et al. Management of cirrhosis and ascites[J]. N Engl J Med, 2004, 35(916): 1646-1654.
  3. 3. Bari K, Garcia-Tsao G. Treatment of portal hypertension[J]. World J Gastroenterol, 2012, 18(11): 1166-1175.
  4. 4. Dzeletovic I, Baron TH. History of portal hypertension and endoscopic treatment of esophageal varices[J]. Gastrointest Endosc, 2012, 75(6): 1244-1249.
  5. 5. de Franchis R, Primignani M. Natural history of portal hypertensionin patients with cirrhosis[J]. Clin Liver Dis, 2001, 5(3):645-663.
  6. 6. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med, 2010, 362(9): 823-832.
  7. 7. Funakoshi N, Duny Y, Valats JC, et al. Meta-analysis:beta-blockers versus banding ligation for primary prophylaxis ofesophageal variceal bleeding[J]. Ann Hepatol, 2012, 11(3): 369-383.
  8. 8. Zippi M, Traversa G, Pica R, et al. Hematemesis from esophagealvarices associated with esophageal perforation:sclerotherapy and endoscopic clipping[J]. Eur Rev Med Pharmacol Sci, 2012, 16(5): 704-706.
  9. 9. Carbonell N, Pauwels A, Serfaty L, et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades[J]. Hepatology, 2004, 40(3): 652-659.
  10. 10. Starzl TE, Marchioro TL, Vonkaulla KN, et al. Homotransplantation of the liver in humans[J]. Surg Gynecol Obstet, 1963, 117: 659-676.
  11. 11. Starzl TE, Fung JJ. Themes of liver transplantation[J]. Hepatology, 2010, 51(6): 1869-1884.
  12. 12. Dienstag JL, Cosimi AB. Liver transplantation—a vision realized[J]. N Engl J Med, 2012, 367(16): 1483-1485.
  13. 13. Orloff MJ. Portal hypertension and portacaval shunt// Souba W, Wilmore D. ed. Surgical Research[M]. Harcourt Brace:San Diego, 2001: 637-701.
  14. 14. Lata J, Hulek P, Vanasek T. Management of acute variceal bleeding[J]. Dig Dis, 2003, 21(1): 6-15.
  15. 15. Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med 2010, 362(25): 2370-2379.
  16. 16. Koizumi J, Hashimoto T, Myojin K, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices:use ofCT-guided foam sclerotherapy to optimize technique[J]. AJR Am J Roentgenol, 2012, 199(1): 200-207.
  17. 17. Tiuca N, Sztogrin W. The news of treatment of variceal upper gastrointestinal bleeding[J]. J Med Life, 2011, 4(4):395-398.
  18. 18. Pomier-Layrargues G, Bouchard L, Lafortune M, et al. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension: current status[J]. Int J Hepatol, 2012, 167868 Epub 2012 Jul 19.
  19. 19. Klupp J, Kohler S, Pascher A, et al. Liver transplantation as ultimate tool to treat portal hypertension[J] . Dig Dis, 2005, 23(1):65-71.
  20. 20. Henderson JM, Yang Y. Is there still a role for surgery in bleeding portal hypertension?[J]. Nat Clin Pract Gastroenterol Hepatol, 2005,2(6): 246-247.
  21. 21. 嚴(yán)律南. 肝硬變門脈高壓癥的肝臟移植經(jīng)驗(yàn)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2001, 19(9): 951-956.
  22. 22. Organ procurement and transplantation network. Liver Kaplan-Meier median waiting times for registrations listed:1999-2004[DB/OL]. http://www. optn. transplant. hrsa. gov. (accessed on 1 NoV. 2012).
  23. 23. Waiting time to transplant[DB/OL]. http://www. organdonation. nhs. uk. (accessed on 1 NoV. 2012).
  24. 24. de Franchis R, Dell’Era A, Iannuzzi F. Diagnosis and treatment of portal hypertension[J]. Dig Liver Dis, 2004, 36(12): 787-798.
  25. 25. Bismuth H, Adam R, Raccuia JS. 肝臟移植治療門脈高壓癥[J]. 德國(guó)醫(yī)學(xué), 1996, 13(3): 157-159.