联合进行肝移植与冠状动脉搭桥手术安全有效

一项对5例肝移植联合冠状动脉搭桥手术的研究显示：这种手术方案安全有效，患者一年死亡率与单独进行肝移植相似。

尽管肝移植已经成为高龄患者的可行治疗方案，但是心血管疾病常常会限制他们接受肝移植手术。同时，某些患者能够安全地接受冠状动脉搭桥手术，但是却在手术中出现肝功能急剧恶化。为了解决这个难题，医生在这5例患者中联合进行了搭桥手术和肝移植手术。手术持续大约了14小时。研究人员分析结果之后得出结论，即这种手术方案在精心选择的患者中是安全有效的。

所有这5例患者都患上了终末期肝病以及冠状动脉血管3个分支的疾病，左心室也只剩下了有限的功能。除了1例肝癌患者之外（为了确保癌细胞不出现扩散），都是先进行心血管手术。所有患者都成功度过了手术期，但是1例患者5个月之后死于丙型病毒性肝炎的并发症。其它患者的术后并发症包括：心包渗出需要再次手术、心搏骤停、急性排异反应以及肺炎。患者在重症监护室接受治疗的时间是2～20天。有利于手术效果的因素包括：精心选择供体、在肝脏移植过程中保持胸腔创面开放以便于及时检查止血情况、以及手术后进行超声监测。

“应当在患严重冠状动脉疾病的患者中进行冠状动脉搭桥手术-原位全肝移植*手术，否则患者将由于心血管风险而无法进行原位全肝移植，”美国西北大学(Northwestern University, Evanston, IL, USA)的Alan Koffron医学博士作者在文章中总结说。他主持了该项研究，文章发表于2004年11月的《肝脏移植杂志》(Liver Transplantation)。

*编者注：目前临床采用的肝移植有原位肝移植、背驼式肝移植、分离式肝移植、减体积肝部分移植、活体肝移植等数种。

Combining Liver Transplant With Bypass Surgery
 
A study of five patients who had liver transplantation combined with coronary artery bypass grafting (CABG) has shown the procedure to be safe and effective, with one-year mortality rates similar to those for a liver transplant alone.

Although liver transplantation has become a viable option for older patients, cardiovascular problems may prevent them from receiving a new liver. At the same time, some patients may safely undergo bypass surgery but experience a rapid decline in liver function during that procedure. To solve this problem, doctors performed bypass surgery combined with a liver transplant in five such patients. The procedure took about 14 hours. Researchers who studied the results concluded that the procedure is safe and effective for carefully selected patients.

All of the five patients had end-stage liver disease as well as three-vessel coronary artery disease with preserved left ventricular function. The cardiac surgery was performed first, except in patients with liver cancer (to ensure the cancer had not spread). All patients survived the surgery, but one died five months later from complications of hepatitis C infection. Other patients had complications that included pericardial effusion requiring re-operation, cardiac arrest, acute rejection, and pneumonia. Patient stays in intensive care ranged from two to 20 days. Factors that contributed to the positive results were careful donor selection, keeping the chest wound open during the liver transplant to inspect for hemostasis, and postoperative monitoring of patients by ultrasound.

“CABG-OLT [orthotopic liver transplantation] should be offered to patients with severe coronary artery disease who would otherwise be denied OLT due to their cardiac risk factors,” concluded the authors. The study was led by Alan Koffron, M.D., of Northwestern University (Evanston, IL, USA), and was published in the November 2004 issue of Liver Transplantation.