同种异体原位肝移植术后远期胆道并发症相关因素的分析
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宋世兵

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Analysis of factors affecting long-term biliary tract complications after orthotopic liver transplantation
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    摘要:

    摘要:目的:探讨同种异体原位肝移植术后远期胆道并发症发生的原因。方法:回顾性分析2年施行的肝移植病例中,存活时间超过6个月的41例肝移植患者的临床资料。其中29例(A组)无远期胆道并发症,12例(B组)有远期胆道并发症。比较两组的一般情况(性别、年龄、原发疾病、术前肝功能等)、供体脑死亡到腹主动脉低温灌注开始的时间(一次热缺血,热缺血时间1)、冷保存时间、门静脉血流复通到肝动脉血流复通的时间(二次热缺血,热缺血时间2)、手术时间、术中出血量、术后肝动脉血栓形成的比例等。结果:平均年龄,A组为(46.9±10.5)岁,B组为(53.7±7.4)岁。二次热缺血时间,A组为(63.38±22.97)min,B组为(81.25±30.87)min。术中出血量,A组为(3 817.2±1 402.3)mL,B组为(5 579.2±1 801.4)mL。以上3项指标两组差异有显著性;其他指标无统计学差异。供肝第一次热缺血时间超过5min,同时冷缺血时间超过8h的病例数,A组为12例(12/29),B组为6例(6/12),两组无统计学差异。结论:第一次热缺血时间及冷保存时间的长短不影响手术后胆道并发症的发生;移植肝第二次热缺血时间延长可以增加术后远期胆道并发症的发生率,高龄患者更易发生胆道并发症。

    Abstract:

    Abstract:Objective:To explore the causative factors affecting long-term biliary tract complications after orthotopic liver transplantation (OLT). Methods:A retrospective analysis of the clinical data of 41 patients who had survived more than 6 months after OLT was undertaken. Among these 41 cases, 29 patients (group A) recovered without any biliary tract complications, but 12 patients(group B) had biliary tract complictions long-term after OLT. The following clinical data were compared between group A and group B: patient′s age and sex, primary disease, liver function grade of recipient, period of donor brain death to aorta cold perfusion(the first warm ischemia period, warm ischaemia time 1), cold ischemia period, period from portal vein reperfusion and hepatic artery reperfusion for new liver(second warm ischemia time), operation period, volume of operative blood loss, and the rate of hepatic artery thrombosis. Results:The patient′s age in group A was younger than that in group B (46.9±10.5 ys vs 53.7±7.4 ys, P<0.05);The second warm ischemia period in group A was shorter than that in group B (63.38±22.97mins vs 81.25±30.87 mins, P<0.05 );The blood loss in group A was less than that in group B (3 817.2±1 402 mL vs 5 579.2±1 801.4mL, P<0.05). The donor liver with first warm ischemia beyond 5 minutes and cold ischemia beyond 8 hours was found in 12 cases(12/29) in group A, and 6 cases in group B (6/12, P>0.05 ). Conclusions:The length of the first warm ischemia period and cold storage period does not affect the occurrence of biliary tract complications. The second warm ischemia period influenced the complications of biliary tract after OLT, and should be as short as possible. It seems that biliary tract complictions occur more frequently in elderly patients following OLT.

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宋世兵,袁炯,修典荣,蒋斌,王昌明,白洋,张同琳.同种异体原位肝移植术后远期胆道并发症相关因素的分析[J].中国普通外科杂志,2006,15(7):5-496.
DOI:10.7659/j. issn.1005-6947.2006.07.005

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  • 在线发布日期: 2006-07-25