活体肝移植术后受体肝脏储备功能和体积变化研究  

Study of Dynamic Changes of Postoperative Liver Reserve Function and Liver Volume Regeneration for Recipients Underwent Living Donor Liver Transplantation

作　　者：尹杰[1] 李波[1] 杜正贵[1] 冯曦[1] 魏永刚[1] 李甫强[1] 严律南[1] 文天夫[1] 唐荔[1] 

机构地区：[1]四川大学华西医院肝脏及周围血管外科,成都610041

出　　处：《中国普外基础与临床杂志》2010年第8期789-794,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨活体肝移植受体围手术期常规肝功能指标、肝脏储备功能和肝脏体积增长动态变化及其与患者近期临床结局的关系。方法收集30例受体术前基本资料,对围手术期常规肝功能指标、吲哚氰绿(ICG)血浆清除率(K)、CT肝体积以及术后近期(3个月内)的并发症情况进行分析。结果供肝重和受体体重比(GRBW)为0.63%～1.43%。受体术中移植肝脏体积为(638±103)ml,术后7、30及90d移植肝脏体积分别增长至(1096±152)ml、(1163±138)ml及(1158±140)ml,均大于术中的体积(P<0.001),但术后各时间点肝脏体积间差异均无统计学意义(P>0.05)。受体术后3、7、30和90d的KICG值逐渐升高〔(0.177±0.056)/min、(0.183±0.061)/min、(0.200±0.049)/min及(0.209±0.050)/min〕,均高于术前值〔(0.123±0.067)/min〕,差异均有统计学意义(P=0.006,P=0.002,P<0.001,P<0.001)。以供体术前KICG值(0.228±0.036)/min为基线,受体术后3d和7d的KICG值低于基线值(P=0.004,P=0.015),而术后30d和90d的KICG值已接近基线值(P=0.355,P=0.915)。根据术后14d总胆红素值将受体分为肝功能良好组(n=23)和肝功能不全组(n=7),与肝功能良好组相比,肝功能不全组术后3d的KICG值明显降低(P=0.001)。结论术后7d是活体肝移植受体肝脏体积增长的活跃期;受体肝脏储备功能的恢复要早于体积的恢复。ICG排泄试验可作为活体肝移植术后受体移植肝功能及预后的早期预测指标。Objective To investigate the dynamic changes of postoperative liver reserve function and laboratory liver function as well as liver volume regeneration,and their potential relationship with short-term clinical outcomes after adult-to-adult living donor liver transplantation （LDLT）. Methods The data of 30 recipients underwent LDLT were prospectively collected. The plasma clearance （K） by indocyanine green （ICG） excretive test,liver function test by laboratory methods,liver volume by CT and short-term （3 months） complications were analyzed. Results The graft recipient body weight ratio （GRBW） was 0.63%-1.43%. The hepatic volume of the recipients in the operation was （638±103） ml,which was smaller than that day 7,30,and 90 after operation （P0.001）,but the hepatic volume at subsequent time point was not different from that at the former time point （P0.05）. The KICG values of recipients among the day 3 〔（0.177±0.056）/min〕,7 〔（0.183±0.061）/min〕,30 〔（0.200±0.049）/min〕,and 90 〔（0.209±0.050）/min〕 after operation gradually increased,which was respectively higher than that of recipients before operation （P=0.006,P=0.002,P0.001,and P0.001）. Compared with the baseline KICG 〔（0.228±0.036）/min〕 of the donors,the KICG of recipients showed significant variation on day 3 and 7 after operation （P=0.004 and P=0.015）,and the KICG of recipients on day 30 and 90 after operation approached the baseline KICG （P=0.355 and P=0.915）. The recipients were divided into good liver function group （n=23） and poor liver function group （n=7） according to total serum bilirubin on day 14 after operation. The KICG significantly dropped compared with the recipients of good liver function group on day 3 after operation （P=0.001）. Conclusion s The liver volume regenerates dramatically on day 7 after operation for the recipients. The ICG excretivetest shows that volume recovery occurs much more gradually than the recovery of function in the recipients. Th

关 键 词：肝脏储备功能 吲哚氰绿排泄试验 体积增长 活体肝移植 

分 类 号：R657.3[医药卫生—外科学]