2014.06.13
陳堯俐帶領彰基肝臟移植團隊
陳堯俐帶領彰基肝臟移植團隊
肝臟移植三年存活率85% 全國第二
【記者王慰祖/專題報導】
健保署日前公布國內器官移植存活率前三名醫院名單,其中,肝臟移植三年存活率的第一名還是以高雄長庚91%位居第一,台大與彰基肝臟移植三年存活率為85%,並列第二名。這個成績出來,不免有人會有疑問,「怎麼會是彰基」。事實上,帶領彰基肝臟移植團隊繳出好成績的,正是最近兩、三年在肝臟移植領域崛起的彰基副院長陳堯俐醫師。親和力十足的陳堯俐醫師,可以說是彰基一手栽培起來的優秀外科醫師,從1990年進入彰基擔任住院醫師,至今成為台灣肝移植成績第二、中部地區最優的權威醫師,不禁讓人好奇,在「先天條件」較不理想的彰化,如何能夠締造這樣的好成績。 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)
(點圖放大)
♦ 剛開始研習肝臟手術 錄影帶當老師
加入彰基已經24年的陳堯俐醫師,最早都是從事肝臟外科,他笑說自己以前都在「切肝」,到後來已經有瓶頸,之後投入肝臟移植領域。
但是他強調,在1998年從巴黎完成受訓返回彰基服務時,當時根本沒有條件執行肝臟移植,不僅沒有人才,肝臟移植的硬體設施都欠缺,包括:麻醉、免疫用藥、檢驗等均沒有到位,更不要說還得建立「勸募」器官捐贈流程,基礎條件相當不理想。
起初陳堯俐醫師開始投入研習肝臟手術,但是當時的環境根本沒有學習的對象,很多時候是看書「自習」,他說「錄影帶就是我的老師」。
♦ 1998年從巴黎受訓後 受教高雄長庚陳肇隆院長
也就是因為欠缺先天的條件, 陳堯俐醫師透過錄影帶教學,開始學習國際大師的手術方式,幾乎所有的大師「手法」他都仔細研讀,自我苦學加上天分,陳堯俐醫師在1998年法國PaulBrousseHospital進修之後,並受教於高雄長庚醫院陳肇隆院長,於2000年取得衛生署器官移植認證合格醫師,2002年10月18日進行第一例肝臟移植手術。
陳堯俐醫師指出,相較其它位於都會區的醫學中心,彰基想要在肝臟移植領域占一席之地,未來所要面臨的挑戰是可以想像的。因為肝臟移植的肝臟來源始終是最大的問題,可以說彰基沒有條件選擇病人,例如:緊急的換肝為了搶時效性,可能成功率就不高,有些醫院就不收,這個時候,彰基能不收嗎?
陳堯俐醫師說,正因為先天條件比不上人家,彰基體認到只有加強自己在肝臟移植的手術技術,以及建構堅強的器官移植團隊,才能夠在此領域占有一席之地。![](../../upload/site_news/9058/483/img-news-20140613-1(ss).jpg)
♦ 不論屍肝或活肝移植 手術成績水準高
經過多年的磨練,陳堯俐醫師帶領的彰基肝臟移植團隊逐漸打響名號,而且因為「屍肝」很少,在肝臟來源不易的情形下,陳堯俐醫師苦練「分肝」的手術技巧,也就是「一肝兩用」,以拯救更多換肝的病患。
但是他強調,雖然「分肝」是現階段最可行的做法,可是如果手術技巧不好,最壞的狀況是造成「一刀三命」,所以,醫師承受的壓力是可想而知的。
陳堯俐醫師表示,一個肝臟移植團隊唯有活肝移植技術好,才能夠進行「分肝」。現在彰基在這個部分已經非常有心得,而且只要是在50歲以下,條件較理想的患者,儘可能以「分肝」為主,在有限的肝臟來源下,以找出更可行的肝臟移植解決方案。
目前陳堯俐醫師帶領的肝臟移植團隊,不論是「屍肝」或「活肝」移植,手術成績都有很高的水準,手術技術也愈來愈純熟,甚至是以往被視為困難的移植瓶頸,現在都可以解決。例如:有一例個案是年輕人想要捐肝救家人,也符合配對條件,但是血型不合,加上捐贈者體重過胖,不易捐肝。
在陳堯俐醫師評估下,讓捐贈者先行置入胃部水球,待體重減下來後,且克服了血型不合的問題,再進行肝臟移植,並且同步利用內視鏡取出胃部水球,最後完成這例血型不合、過胖,以往被視為「不可能的任務」肝臟移植手術。
♦ 藉用人工網膜 克服捐肝SIZE不合問題
陳堯俐醫師說,肝臟移植的「眉角」很多,但是對於彰基肝臟移植團隊已不是太大的問題。例如:常見的膽道、動脈、靜脈或門脈大小不一,或是膽道有二、三條等,這些問題組合起來,讓肝臟移植手術變得更為複雜。
陳堯俐醫師說,肝臟移植的「眉角」很多,但是對於彰基肝臟移植團隊已不是太大的問題。例如:常見的膽道、動脈、靜脈或門脈大小不一,或是膽道有二、三條等,這些問題組合起來,讓肝臟移植手術變得更為複雜。
還有些個案是雙方的SIZE不合,也就是捐贈者的肝臟特別大,無法移植到受捐者身上。陳堯俐醫師藉由「人工網膜」克服了這個問題,即先以人工網膜蓋住捐贈者的肝臟,並且縫合起來。經過一週後,再拿掉人工網膜,讓肝臟體積縮小後再進行移植。
相反的,如果是肝臟太小,移植後容易「掉下去」,陳堯俐醫師表示,這也是有方法可以克服的,只要先將位於下方的橫隔膜縫小一點,就可以克服捐贈者肝臟太小的問題。之前他就曾經為一位體重只有40公斤的女性捐贈者,成功將肝臟移植到體重多達2.5倍的父親身上,增添一例捐肝救父的佳話。