目的 探讨肝癌复发与未复发患者再次肝移植的效果.方法 初次肝移植时原发疾病为肝癌(病理诊断)、移植后因各种原因需行再次肝移植者65例(肝癌组),分析其进行再次肝移植的原因以及再次肝移植后的并发症发生情况和预后,并于同期因肝脏良性疾病施行肝移植、移植后因各种原因需行再次肝移植者66例(非肝癌组)进行比较.结果 肝癌组初次肝移植后有11例(16.9％,11/65)因肝癌复发而行再次肝移植,非肝癌组无因肝癌而行再次移植者,两组比较,差异有统计学意义(P＜0.01)；非肝癌组初次肝移植后有11例(16.7％0,11/66)因血管并发症而进行再次肝移植,高于肝癌组(4.6％,3/65),差异有统计学意义(P＜0.05).肝癌组初次肝移植后肝癌复发者11例,其中10例(90.9％,10/11)在再次肝移植后因肝癌复发而死亡；肝癌组初次肝移植后肝癌未复发者54例,其中7例(13.0％,7/54)在再次肝移植后肝癌复发,明显低于复发者(P＜0.01),其移植肝5年累积存活率为51.0％,与非肝癌组(51.8％)差异很小(P＞0.05).结论 原发病为肝癌者初次肝移植后因肿瘤复发而行再次肝移植,其预后不佳；而因非肿瘤复发因素而行再次肝移植时,其再次肝移植的效果与因良性疾病而行肝移植者相近,不应受其原发疾病为肝癌的影响.

Objective To explore the efficacy of liver retransplantation for hepatocellular carcinoma (HCC) patients with or without HCC recurrence.Method 131 cases of retransplantation performed between 2003 and 2012 were analyzed retrospectively.Their first and second liver transplantations were both performed in our hospital.Diagnoses of their primary diseases before transplantations were confirmed pathologically after the first transplantation.Patients were divided into two groups in terms of benign causes and HCC.Results Sixty cases were fallen into benign disease group and 65 cases into HCC group.The proportions of main causes of retransplantation were similar between two groups.The graft survival rate of early retransplantation (retransplantation performed within 30 days after the first transplantation) and late retransplantation (retransplantation performed beyond 30 days after the first transplantation) was calculated and compared respectively due a great difference in survival rate betwe

背景:尿毒症患者肾移植前均处于不同程度的贫血状态,围移植期贫血对机体肾移植中、后恢复以及移植肾功能恢复均产生不利影响。目的:观察接受逝世者器官捐献肾移植与亲属活体肾移植围移植期贫血程度及输血总量对肾移植的影响。总结二者围手术期药物抗贫血治疗及输血原则。方法:回顾性研究郑州大学第一附属肾移植中心2012年1月至2013年12月接受逝世器官捐献肾移植115例为试验组,对照组为同期亲属活体肾移植92例,分析两组贫血程度的相关指标以及围移植期输血总量、输血12 h内电解质的变化,记录输血后不良反应事件发生情况等。结果与结论:2组患者贫血发生率差异无显著性意义(P0.05);而试验组患者移植中及移植后输血比率、平均输血总量高于对照组(P0.05),移植前红细胞水平、血红蛋白值、红细胞压积、平均血红蛋白值含量、平均血红蛋白值浓度均明显低于对照组(P0.05)。2组患者输血过程中主要不良事件为发热反应(5.5%),未见严重的过敏反应及电解质酸碱平衡紊乱等。提示接受逝世者器官捐献肾移植受者较亲属活体肾移植围移植期贫血程度高;移植前抗贫血药物应用,纠正机体贫血状态至关重要;应严格按照围移植期输血原则进行移植中和(或)移植后输血治疗。

BACKGROUND:Uremia patients have different degree of anemia before kidney transplantation, preoperative, and perioperative anemia is harmful to intraoperative and postoperative recovery of the organism and renal function. OBJECTIVE:To observe the effects of perioperative anemia degree and total blood transfusion on non-living and living-relative donor kidney transplantation, and to summarize the perioperative drug treatment for anemia and perioperative principles of blood transfusion. METHODS: A retrospective study was done in 115 cases of non-living donor kidney transplantation (test group) and 92 cases of living-relative donor kidney transplantation (control group) from January 2012 to December 2013. Degree of anemia, total perioperative blood transfusion, electrolyte change within 12 hours of blood transfusion, and adverse events after blood transfusion were recorded and analyzed. RESULTS AND CONCLUSION:The incidence of anemia had no significant difference between the two g

人体器官移植为20世纪生物工程领域中具有划时代意义的技术。我国是世界上第二大人体器官移植国，然而近年来非法器官移植现象日益增多，我国现行法规对人体器官移植犯罪惩处力度不够。器官移植应依法进行，为了给我国人体器官移植犯罪科学立法提供借鉴，通过比较分析，发现俄罗斯器官移植犯罪直接入刑法，我国器官移植犯罪为间接入刑，规定不完善，配套法律缺失，附加民事责任不具体，没有对被害人的赔偿条款。建议我国刑法设置非法器官移植犯罪，并附加具体的民事责任。

Human organ transplantation is the most epoch -making technology of biology engineering in the 20th century . China ranks secondly in the practice of human organ transplantation .However ,the illegal human organ transplanting increases in recent years ,and the punishment of it is not adequate .As an example ,the law of human organ transplantation in Russia can be a reference to use .The law in Russia imposes criminal judgment on the crime of illegal human organ transplantation directly . On the contrary , China imposes criminal judgment on the crime of illegal human organ transplantation indirectly ,and there is no concrete additional civic liability with it ,including indemnity clauses to the aggrieved person .Besides ,the stipulations are defective ,and the supporting laws are deficient .Therefore ,there is a suggestion that the penal code in China should set a crime of illegal human organ transplantation with additional civic liability .

目的 探讨沙利度胺对大鼠移植动脉慢性移植物血管病的改善作用及其机制.方法 以Brown-Norway大鼠和Lewis大鼠制备大鼠腹主动脉慢性移植物血管病模型,模型分为3组:(1)同系移植对照组,供、受鼠均为Brown-Norway大鼠,术后每天以生理盐水灌胃至术后60 d；(2)异系移植对照组,以Brown-Norway大鼠为供鼠,Lewis大鼠为受鼠,受鼠术后每天以生理盐水灌胃至术后60 d;(3)异系移植实验组,以Brown-Norway大鼠为供鼠,Lewis大鼠为受鼠,受鼠术后以沙利度胺100mg·kg-1·d-1灌胃60 d.术后60 d切取移植血管分别在光镜下观察移植物血管组织形态学的变化,在电子显微镜下观察血管内皮细胞及中膜平滑肌超微结构的变化；采用免疫组织化学法测定移植动脉组织中血管内皮细胞生长因子(VEGF)的表达.结果 光镜下,异系移植对照组和异系移植实验组血管内膜增生程度超过同系移植对照组(P＜0.05)；异系移植实验蛆内膜增生程度较异系移植对照组轻(P＜0.05).透射电镜下,与同系移植对照组相比较,异系移植对照组和异系移植实验组内皮细胞变性坏死,平滑肌细胞固缩明显,中性粒细胞空泡变性程度重；异系移植实验组内皮细胞、平滑肌细胞变性坏死程度较异系移植对照组轻.同系移植对照组移植动脉中VEGF阳细胞数为(1.218±0.118)个,低于异系移植对照组的(32.124±2.003)个和异系移植实验组的(10.873±1.932)个(P＜0.05)；异系移植实验组VEGF阳细胞数低于异系移植对照组(P＜0.05).结论 沙利度胺具有缓解慢性移植物血管病的作用,机制可能与VEGF表达下调和内皮细胞结构功能改变相关.

Objective To study the role and function change of the vascular endothelial cells in chronic graft disease,and to study the protective effects of thalidomide on the development of allograft vasculopathy and its potential mechanisms.Method Rat abdominal aorta transplantation was performed on male Brown-Norway (BN) rats as donors and male Lewis rats as recipients.The recipients were divided into 3 group: allograft control group (BN-Lewis) and isograft control group (BN-BN) with administration of sodium chloride,and experimental group (BN-Lewis) administered with thalidomide for 60 days postoperatively.All recipients were killed to harvest transplanted aorta at 60th day after transplantation.HE staining was used to observe the histological changes.The vascular endothelial cell growth factor (VEGF) expression was detected by using immunohistochemical method.Electron microscope was used to observe the ultra-structure of the vascular endothelial cells and the smooth muscles.Result Isograft c

肝移植是被全世界认可的治疗终末期肝病的有效手段之一.目前,肝移植在全国范围内已得到广泛开展,亟待相关临床实践指南来指导全国肝移植工作更规范、有效、安全地开展.中华医学会器官移植学分会、中华医学会外科学分会移植学组及中国医师协会器官移植医师分会组织专家制订了《中国肝癌肝移植临床实践指南(2014版)》,重点阐述肝移植受者选择标准、术前降期治疗、受者抗病毒治疗、受者免疫抑制剂应用、术后肿瘤复发的防治5部分内容.米兰标准是肝癌肝移植受者选择的参考基准,而杭州标准是对米兰标准局限于肿瘤形态学的巨大突破.肝癌肝移植术前肿瘤降期治疗可使不满足肝癌肝移植受者选择标准的患者能够被纳入移植标准,获得肝移植机会.对于乙型病毒性肝炎肝癌肝移植受者行抗病毒治疗,有助于降低移植术后乙型病毒性肝炎复发率,提高受者长期生存率.目前主张个体化的低剂量免疫抑制方案以达到最大限度保护移植肝脏功能,同时减轻其毒副作用,减少移植后肝癌复发.肝癌肝移植术后复发的防治可采用手术、TACE、局部消融以及放射免疫、靶向治疗、系统性化疗等手段,为受者制订个体化治疗方案.

Liver transplantation is still one of the most effective treatments for end-stage liver diseases.Presently,liver transplantation has been widely carried out around China,and a clinical practice guideline is necessary for more standard,effective and safer application of liver transplantation.Therefore,the Chinese clinical practice guideline on liver transplantation for hepatocellular carcinoma (HCC) was developed by the experts from Chinese Society of Organ Transplantation; Section of Organ Transplantation,Chinese Society of Surgery; Chinese College of Transplant Doctors.The Chinese clinical practice guideline on liver transplantation for HCC mainly focused on the following 5 parts:recipients selection criteria for liver transplantation,preoperative down-staging treatments,antiviral therapies,applications of immunosuppressant and postoperative treatment for prevention of HCC recurrence.Milan criteria are regarded as the international standard for selecting recipients,while the Hangzhou