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目的探讨肝肾联合移植的手术技术、围手术期处理、感染及排斥等并发症的防治措施。方法对1例66岁酒精性肝硬化终末期并慢性肾功能不全尿毒症患者施行一期肝肾联合移植。供体器官采用UW液联合原位灌洗、整块切取,肝移植采用原位非转流移植技术,肾移植采用常规方法置于右髂窝。术后免疫抑制剂采用普乐可复、霉酚酸酯、抗胸腺淋巴细胞球蛋白和皮质类固醇激素联合应用,行免疫指标及移植肝、肾多普勒超声监测。结果移植后肝、肾立即发挥作用,术后24 h胆汁380 ml,尿量8 500 ml,第3天肝、肾功化验指标正常,术后第10天移植肝发生急性排斥反应,经调整普乐可复浓度并行甲基强地松龙冲击治疗后控制。术后第29天康复出院。随访1年肝肾功能正常,日常生活自理。结论肝肾联合移植是治疗肝、肾同时衰竭的有效方法,良好的组织配型、娴熟的技术、免疫抑制剂的合理应用、术后并发症的正确处理是成功的关键。
Objective To investigate the surgical techniques of liver-kidney transplantation, perioperative management, infection and rejection and other complications prevention and treatment. Methods One case of 66-year-old patients with terminal hepatic cirrhosis with chronic renal insufficiency underwent combined liver-kidney transplantation. Donor organs were treated with UW solution combined with in-situ lavage and lump resection. Transplantation was performed in situ on non-diverting liver transplantation. The renal transplantation was performed in the right iliac fossa by conventional methods. The postoperative immunosuppressive agents were treated by combination of pullucut, mycophenolate mofetil, anti-thymus lymphocyte globulin and corticosteroids. Immunohistochemistry and transplanted liver and renal Doppler echocardiography were performed. Results Liver and kidney were transplanted immediately. After operation, 380 ml of urine and 8 500 ml of urine were obtained 24 h after operation. The indexes of liver and kidney were normal on the third day, and acute rejection occurred on the 10th day after transplantation. Le Concorde concentration of methylprednisolone shock after treatment control. After 29 days of rehabilitation discharged. Follow-up 1 year liver and kidney function is normal, take care of themselves daily. Conclusion Combined liver and kidney transplantation is an effective method to treat simultaneous liver and kidney failure. Good tissue matching, skilled technique, reasonable application of immunosuppressive agents and correct treatment of postoperative complications are the keys to success.