| Based on the rapid development of modern surgical internal organ preservation and peri-surgical period treatment technolog as well as transplantation immunology, the technology of liver transplantation has formed a relatively mature process since 1963 when the first orthotopic liver transplantation was made. The liver transplantation is expected to play an irreplaceable role in the treatment of terminal liver trouble owing to the enough organ supply and the further breakthrough of anti-rejection technology.China is one of the countries in the world with the highest morbidity of liver troubles. China's liver transplantation began in the late 1970s, and began to see a rapid development in the mid and late 1990s. Recently the number of liver transplantation has tended to increase rapidly and it has attained the death rate within the peri-surgical period lower than 3% and the annual morbidity of recipents exceeding 80%. Starting from the Chinese reality and compared with the international standard, the China's liver transplantation cause, however, still has a long way to go, has many problems to be solved and needs a deeper and more systematic study and research. This thesis, by analysing the main factors influencing the post-surgical survival of the liver transplantation recipients, attempts to explore the measures for improving the post-surgical survival rate and the quality of life.Data and MethodsThe Liver Transplantation Center of No. One Hospital attached to the MedicalCollege of Zhejiang University had finished 142 cases of liver transplantation operation during the period from April of 1993 to March of 2003. The author of this thesis finished setting up the databank by means of taking part in the clinical liver transplantation surgeries and having the follow-up interviews with the post-surgical patients. Of the 142 cases, 110 cases were male and 32 cases were female patients, whose age varied from 10 to 65 with the average age ol 45. and there were 119 cases whose ABO groups were identical and 23 cases whose ABO groups were compatible between donors and recipients. There were 69 cases of terminal benign liver trouble and 55 cases of malignant liver tumour. Apart from 6 cases of combined transplantation of the liver and the kidney and 2 cases of partial liver transplantation from living bodies, there were altogether 134 cases whose transplanted livers were classic situ from corpses. 51 cases were conducted by using the immunosuppressive agent with the CsA as the main ingredient and 76 cases were conducted by employing the immunosuppressive agent with the FK506 as the major element.The 17 items of indexes for multi-factors analysis were determined, and then were quantized, namely, in terms of sex, age, blood type, recipient's primary disease(DIAGAB), whether the blood types of donor and recipient are identical(BGPAIR), UNOS assessment of pre-operation, Child scale of liver function(CHILD), prolonged time of PT, cold ischemic time of donor's liver, veno-venous bypass in operation, whether the T-tube was put in choledocholedochostomy in operation, Ahepatic time(AHT), duration of operation, post-operation complication and employment of immunosuppressive agent(IMMUNOSU).The databank was set up by means of the software SPSS 10.0. With the survival time after liver transplantation as the dependent variant and the survival-or-death status at the end of the operation as the state variable, the cases of incomplete clinical and interview data among the 142 cases were deleted, and the 17 indexes from 80 recipients of complete data were used in Cox ratio risk model analysis.ResultsWe found, through observation, that 142 cases of liver transplantation had been made by the time of May 8, 2003, among which 55 patients were dead and 87 survived, 6 cases had the hepatic artery thrombosis, 15 cases had the narrow biliary tract, 21 cases had the acute rejection and 6 cases had the chronic rejection. In the 80 recipients of complete data, the survival rates of the cases who had the benign liver disease...
|
PDF Full Text Request