一項對5例肝移植聯(lián)合冠狀動脈搭橋手術(shù)的研究顯示：這種手術(shù)方案安全有效，患者一年死亡率與單獨(dú)進(jìn)行肝移植相似。

盡管肝移植已經(jīng)成為高齡患者的可行治療方案，但是心血管疾病常常會限制他們接受肝移植手術(shù)。同時，某些患者能夠安全地接受冠狀動脈搭橋手術(shù)，但是卻在手術(shù)中出現(xiàn)肝功能急劇惡化。為了解決這個難題，醫(yī)生在這5例患者中聯(lián)合進(jìn)行了搭橋手術(shù)和肝移植手術(shù)。手術(shù)持續(xù)大約了14小時。研究人員分析結(jié)果之后得出結(jié)論，即這種手術(shù)方案在精心選擇的患者中是安全有效的。

所有這5例患者都患上了終末期肝病以及冠狀動脈血管3個分支的疾病，左心室也只剩下了有限的功能。除了1例肝癌患者之外（為了確保癌細(xì)胞不出現(xiàn)擴(kuò)散），都是先進(jìn)行心血管手術(shù)。所有患者都成功度過了手術(shù)期，但是1例患者5個月之后死于丙型病毒性肝炎的并發(fā)癥。其它患者的術(shù)后并發(fā)癥包括：心包滲出需要再次手術(shù)、心搏驟停、急性排異反應(yīng)以及肺炎。患者在重癥監(jiān)護(hù)室接受治療的時間是2～20天。有利于手術(shù)效果的因素包括：精心選擇供體、在肝臟移植過程中保持胸腔創(chuàng)面開放以便于及時檢查止血情況、以及手術(shù)后進(jìn)行超聲監(jiān)測。

“應(yīng)當(dāng)在患嚴(yán)重冠狀動脈疾病的患者中進(jìn)行冠狀動脈搭橋手術(shù)-原位全肝移植*手術(shù)，否則患者將由于心血管風(fēng)險而無法進(jìn)行原位全肝移植，”美國西北大學(xué)(Northwestern University, Evanston, IL, USA)的Alan Koffron醫(yī)學(xué)博士作者在文章中總結(jié)說。他主持了該項研究，文章發(fā)表于2004年11月的《肝臟移植雜志》(Liver Transplantation)。

*編者注：目前臨床采用的肝移植有原位肝移植、背駝式肝移植、分離式肝移植、減體積肝部分移植、活體肝移植等數(shù)種。

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.