摘要
目的 分析青岛大学附属医院行肝移植手术的1 147例患者的预后情况,总结提高肝移植疗效的措施.方法 回顾性分析青岛大学附属医院1 147例肝移植患者的临床及随访资料.结果 1 147例肝移植患者术后1、3、5年总体生存率分别为87.20％、73.40％、65.60％.良性疾病肝移植受者组术后1、3、5年生存率分别为88.01％、84.98％、81.39％.恶性疾病肝移植受者组术后1、3、5年生存率分别为78.11％、64.41％、60.06％.良性疾病肝移植受者组生存率显著优于恶性疾病肝移植受者组(P＜0.001).中后期手术组患者术后1、3年的生存率分别为84.20％、70.80％;90.50％、71.70％,后期的生存率要优于中期(P=0.022).复杂手术组患者术后1、3、5年的存活率分别为82.70％、65.50％、56.70％;普通手术组患者术后1、3、5年的存活率分别为89.00％、76.50％、69.20％.普通手术组生存率显著优于复杂手术组(P＜0.001).良性疾病受者死亡原因主要为多器官功能衰竭(4.1％),恶性疾病受者死亡原因主要为恶性肿瘤复发(23.7％).术后原发性移植物无功能、移植肝功能延迟恢复、门静脉栓塞、肝动脉栓塞、胆管狭窄、移植后淋巴组织增生性疾病、移植物抗宿主病发生率分别为1.05％、6.89％、1.92％、0.44％、2.00％、0.61％、0.44％.结论 本中心随着手术技术及围手术期处理水平日益提高,受者近3年生存率有所升高.恶性疾病及复杂肝移植是影响受者预后的重要因素.
Abstract
Objective To analyze the prognostic outcomes of 1 147 patients who underwent liver transplantation at Qingdao University Affiliated Hospital and to summarize measures to enhance the efficacy of liver transplantation.Methods A retrospective analysis was conducted on the clinical and follow-up data of 1 147 liver transplant patients at Qingdao University Affiliated Hospital.Results The overall postoperative 1-,3-,and 5-year survival rates for the 1 147 liver transplant patients were 87.20％,73.40％,and 65.60％,respectively.The survival rates for benign disease liver transplant recipients were 88.01％,84.98％,and 81.39％at 1,3,and 5 years post-transplant,respectively,compared to recipients transplanted for malignancies of 78.11％,64.41％,and 60.06％(all P＜0.001).Among the mid vs more recent period,patients'1-year and 3-year postoperative survival rates were 84.20％,70.80％vs 90.50％,71.70％,respectively,significantly in favor of recently enrolled patients(P=0.022).In the complex surgery group,patients'1-,3-,and 5-year survival rates were 82.70％,65.50％,56.70％,while in less complicated group,it was 89.00％,76.50％,69.20％(P＜0.001).The primary causes of death for benign disease recipients were multi-organ failure(4.1％),while in recipients with malignant disease primary cause of death was tumor recurrence(23.7％).Postoperative complications included primary graft dysfunction,delayed graft function recovery,portal vein thrombosis,hepatic artery thrombosis,biliary stricture,post-transplant lymphoproliferative disorder,and graft-versus-host disease,with occurrence rates of 1.05％,6.89％,1.92％,0.44％,2.00％,0.61％,and 0.44％,respectively.Conclusions With the continuous improvement in surgical techniques and perioperative care levels,the 3-year survival rate of recipients at our center has increased.Malignant diseases and complex liver transplantation remain crucial factors affecting recipient prognosis,highlighting the need to further enhance comprehensive treatment capabilities for patients with malignant diseases and complex surgeries.
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