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目的分析肝癌肝移植围手术期死亡的原因,总结肝癌切除术后行肝移植的临床经验。方法回顾性分析2003年10月至2008年10月中山大学附属第三医院肝移植中心81例肝癌肝移植的临床资料,对其中10例围手术期(≤30d)死亡原因进行分析。结果肝癌切除术后病人肝移植总病死率为12.3%(10/81)。首次肝切除术后肝移植病死率为12.7%(9/71);再次肝癌肝移植病死率为10%(1/10)。补救性肝移植病死率为10%(4/40),超越补救性肝移植病死率16.1%(5/31)。肺部感染(6例)和术中腹腔大出血(5例)是围手术期的主要死亡原因。手术相关死亡5/10,5例术中腹腔出血量均>10000mL。结论肝癌肝移植围手术期病死率仍较高;肺部感染和术中腹腔大出血是围手术期的主要死亡原因。
Objective To analyze the causes of perioperative death in patients with liver cancer undergoing liver transplantation and summarize the clinical experience of liver transplantation after liver cancer resection. Methods The clinical data of 81 patients with liver cancer undergoing liver transplantation from the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to October 2008 were retrospectively analyzed. The causes of death in 10 patients during the perioperative period (≤30 days) were analyzed. Results The overall liver transplant mortality after liver cancer resection was 12.3% (10/81). The mortality of liver transplantation after primary hepatectomy was 12.7% (9/71). The mortality of liver transplantation after reoperation was 10% (1/10). The mortality rate of salvage liver transplantation was 10% (4/40), exceeding the mortality of salvage liver transplantation 16.1% (5/31). Pulmonary infections (6 cases) and intraoperative intra-abdominal hemorrhage (5 cases) were the major causes of perioperative death. Surgery-related death 5/10, 5 cases of intraoperative abdominal bleeding were> 10000mL. Conclusion The perioperative mortality rate of liver cancer is still high. Pulmonary infection and perioperative intra-abdominal hemorrhage are the major causes of perioperative death.