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目的评价非生物人工肝支持系统(ALSS)联合肝移植治疗中晚期慢性重型肝炎的临床应用价值。方法采用ALSS联合肝移植治疗28例中晚期慢性重型肝炎患者,观察治疗前后各项临床指标的变化与疗效,并就治疗后生存率与同期内科治疗组99例患者、内科联合ALSS治疗组30例患者比较。数据行t和X~2检验。结果28例患者共成功进行57次ALSS治疗,TBil、PT、胆汁酸、BUN、Cr、血氨等指标明显好转(P<0.05),临床症状改善的中位时间为3 d(1～153 d)。28例均顺利完成肝移植术。等待到供肝的中位时间为20 d(1～153 d)。术后3、6个月生存率(71.4%,71.4%)显著高于内科治疗组(18.2%,11.1%)和内科联合ALSS治疗组(36.7%,26.6%)(P<0.01)。结论术前应用非生物人工肝治疗,可有效改善中晚期慢性重型肝炎患者的病情,为顺利过渡到肝移植发挥桥梁支持作用。人工肝联合肝移植是有效治疗中晚期慢性重型肝炎的可靠方法。
Objective To evaluate the clinical value of non-biological artificial liver support system (ALSS) combined with liver transplantation in the treatment of advanced chronic severe hepatitis. Methods A total of 28 patients with chronic severe hepatitis were treated with ALSS combined with liver transplantation. The changes and clinical effects of various clinical indexes before and after treatment were observed. The survival rates of the patients in the medical treatment group were compared with those in the medical treatment group (n = 99) Comparison of patients. Data line t and X ~ 2 test. Results A total of 57 ALSS treatments were successfully performed in 28 patients. The indexes of TBil, PT, bile acid, BUN, Cr and ammonia were significantly improved (P <0.05). The median time to clinical symptom improvement was 3 days ). Twenty-eight patients underwent liver transplantation successfully. The median time to wait for donor liver was 20 days (1 to 153 days). The survival rates at 3 and 6 months after operation were significantly higher than those in the medical treatment group (71.2%, 71.1%) and those in the medical combined ALSS group (36.7%, 26.6%, P <0.01). Conclusion Preoperative application of non-bioartificial liver therapy can effectively improve the disease of patients with chronic severe hepatitis in the late stage, and play a bridge supporting role for the smooth transition to liver transplantation. Artificial liver transplantation combined with liver transplantation is a reliable method for the treatment of advanced chronic severe hepatitis.