目的探讨肝脏移植术后早期肠内营养支持的价值。方法在术中将鼻肠管放置至屈氏韧带或空肠输出袢下30 cm， 术后第2天开始恒速灌注瑞素，量由500 ml/d逐渐增加到1 200 ml/d，速度由20 ml/h增至100 ml/h。分别于术后第2天及第8天观察患者的白蛋白、前白蛋白、转铁蛋白、尿尿素氮和氮平衡。结果前白蛋白、转铁蛋白和氮平衡均有显著改善，白蛋白无明显变化。结论肝脏移植术后早期肠内营养支持可以有效改善患者的营养状况和促进患者的恢复，并且可以减少患者的营养支持费用。
Ｎｉｎｅｔｙ ｃａｓｅｓ ｏｆ ｓｕｒｇｉｃａｌｌｙ ｔｒｅａｔｅｄ ｒｅｃｕｒｒｅｎｔ ｈｅｐａｔｏｃｅｌｌｕｌａｒ ｃａｒｃｉｎｏｍａ ｉｓ ｒｅｐｏｒｔｅｄ ｗｉｔｈ ａｎａｌｙｓｉｓ ｏｆ ｔｈｅ ｍａｃｈａｎｉｓｍ ｏｆ ｒｅｃｕｒｒｅｎｃｅ ａｎｄ ｆａｃｔｏｒｓ ａｆｆｅｃｔｉｎｇ ｔｕｍｏｒ ｒｅｃｕｒｒｅｎｃｅ． Ｅａｒｌｙ ｄｅｔｅｃｔｉｏｎ ｏｆ ｒｅｃｕｒｒｅｎｃｅ ｄｅｐｅｎｄｓ ｏｆ ＡＦＰ ｍｅａｓｕｒｅｍｅｎｔｓ ａｎｄ ｕｌｔｒａｓｏｎｏｇｒａｐｈｙ ｆｏｌｌｏｗｕｐ ｍｏｎｉｔｏｒｉｎｇ ａｆｔｅｒ ｒｅｓｅｃｔｉｏｎ． Ｈｅｐａｔｉｃ ｒｅｓｅｃｔｉｏｎ ｉｓ ｔｈｅ ｆｉｒｓｔ ｃｈｏｉｃｅ ｏｆ ｔｒｅａｔｍｅｎｔ ｗｈｅｎｅｖｅｒ ｉｔ ｉｓ ｆｅａｓｉｂｌｅ． Ｉｎｔｒａｔｕｍｏｒ ｅｔｈａｎｏｌ ｉｎｊｅｃｔｉｏｎ ａｎｄ ｔｒａｎｓｃａｔｈｅｔｅｒ ａｒｔｅｒｉａｌ ｃｈｅｍｏｅｍｂｏｌｉｚａｔｉｏｎ ｄｕｒｉｎｇ ｏｐｅｒａｔｉｏｎ ｈａｓ ｂｅｅｎ ｂｅｎｅｆｉｃｉａｌ ｉｎ ｓｏｍｅ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｕｎｒｅｓｅｃｔａｂｌｅ ｒｅｃｕｒｒｅｎｔ ｈｅｐａｔｏｃｅｌｌｕｌａｒ ｃａｒｃｉｎｏｍａ． Ｔｈｅｓｅ ｒｅｓｕｌｔｓ ｓｕｇｇｅｓｔ ｔｈａｔ ｒｅｏｐｅｒａｔｉｏｎ ｆｏｒ ｒｅｃｕｒｒｅｎｔ ｈｅｐａｔｏｃｅｌｌｕｌａｒ ｃａｒｃｉｎｏｍａ ｍａｙ ｂｅ ａｎ ａｐｐｒｏａｃｈ ｔｏ ｉｍｐｒｏｖｅ ｔｈｅ ｌｏｎｇｔｅｒｍ ｓｕｒｖｉｖａｌ ａｆｔｅｒ ｈｅｐａｔｉｃ ｒｅｓｅｃｔｉｏｎ．
目的报告1例分期肝肾联合移植，并探讨分期肝肾联合移植治疗技术及其效果。方法对1例晚期乙型肝炎肝硬变伴肾功能衰竭患者实施原位肝移植术，所用免疫抑制方案为环孢霉素A与甲基强的松龙联合用药，于肝移植术后3个月行肾移植术。结果肝移植术后肝功能恢复良好，但肾功能持续恶化，经血液透析治疗无效而行肾移植术。患者肝肾联合移植术后9个月，一般情况良好，移植肝和移植肾功能均正常。结论对肝移植后各种原因导致的肾功能衰竭，当血液透析治疗无效时可再行肾移植术。同时，免疫抑制剂用量并未增加。
ObjectiveTo evaluate and summarize the perioperative management experience of living related liver transplantation (LRLT). MethodsA retrospective analysis was made in perioperative management of 13 cases undergoing LRLT (15 times operation, including 2 cases of liver retransplantation) in our department from January 2001 to December 2002. ResultsAll the operations were successful. All the 13 donors were followed up regularly, 12 donors were uneventfully recovered after operation and 1 donor suffered from bile leakage due to T tube. The survival rate of recipients, who achieved longterm survival at 2 months to 2 years, was 92.3%(12/13); the survival rate of graft was 86.7%(13/15). One adult recipient with Wilson’s disease died of serious rejection on the 72nd day postoperatively. Two cases suffered from embolism of hepatic artery, one case received reduced size cadaveric liver retransplantation, the other case received liver retransplantation from cadaver, and they both achieved longterm survival after retransplantation. The other complications included: 1 case of serious rejection, 2 cases of ARDS, 6 cases of infection of microbe, 7 cases of serious hydrothorax, 1 cases of leakage of biliary tract, and so on. ConclusionPerfect preoperative management, which composes one of the key parts of LRLT, is critically important for both donor and recipient.