活体肝移植术后肝动脉缓冲效应与胆道并发症及小体积综合征的关系  

Relationship between hepatic arterial buffer response and early biliary complications and small-for-size syndrome after living donor liver transplantation

作　　者：钱道海[1] 刘钦[1] 汪小辉[1] 潘春鹏[1] 沈柏用[1] 鲍国清[1] 王以巧[1] 彭承宏[1] 祝哲诚[1] 邓侠兴[1] 詹茜[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科肝胆胰及肝移植中心,200025

出　　处：《中华肝胆外科杂志》2012年第6期411-415,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市科委《小体积肝移植术后胆道并发症的预防及干预研究》课题资助（09411952100）

摘　　要：目的研究活体肝移植术后肝动脉缓冲效应（hepatic arterial buffer response，HABR）与肝功能恢复、早期胆道并发症及小体积综合征（small—fov size syndrome，SFSS）的关系。方法通过监测34例活体肝移植受者术前及术后肝动脉缓冲效应相关参数（肝动脉及门静脉流量等），结合肝功能、超声、CT及内镜逆行胆胰管造影（ERCP），分析其与早期胆道并发症及小体积综合征的关系。结果34例患者中11例术后早期（被动）肝动脉缓冲效应一直存在（组1），23例消失（组2）。组1患者术后丙氨酸转氨酶（ALT）（11．6±9．0）d、天冬氨酸转氨酶（AST）（10．6±8．8）d、总胆红素（TBil）（平均29d）的恢复快于组2，但差异无统计学意义（P〉0．05）。组1患者在早期胆道并发症和小体积综合征（SFSS）的总发生率（分别为9％和37．0％）上显著低于组2（分别为39．0%和65．0％），差异有统计学意义（P〈O．05）。结论活体肝移植术后早期多数患者（被动）肝动脉缓冲效应消失，这很可能是导致早期胆道并发症及小体积综合征的原因；术后早期监测肝动脉缓冲效应能预测并防治早期胆道并发症及小体积综合征，避免移植手术失败。Objective To study the relationship between hepatic arterial buffer response （HABR）, recovery of liver function, early biliary complications and small-for-size syndrome （SFSS）. Methods Early hepatic hemodynamic parameters （including hepatic arterial flow （HAF）, portal ve- nous flow （PVF） were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation （preoperatively n = 26, intraoperatively n = 26） and on postoperative days 1, 2, 3, and 7. Alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total biliru- bin （TBIL） level were measured preoperatively and on postoperative days 1, 2, 3, 7, 14, 21, and 28. If TBIL level was elevated, we used B ultrasonography or CT and even ERCP to diagnose early biliary complications. The days taken for AST, ALT and TBIL to recover and the number of patients with early （〈60 days） biliary complications （bile leakage or bile stricture） and with small-for-size syn- drome （SFSS） were recorded. Results Passive hepatic artery buffer response （HABR） was present in 11 patients early after living donor liver transplantation （group 1） and it disappeared in 23 patients （group 2）. The recovery in days taken for normalization of AST （10.6±8.8）, ALT （11.6±9.0） and TBIL （average of 29） in group 1 were shorter than in group 2. However, the differences did not reach statistics difference （P〉0. 05）. The overall incidences of early biliary complications and small-fovsize syndrome （SFSS） in group 1 were significantly lower than in group 2 （P=0. 04）. The survival rate in group 1 was 82%, compared with 740% in group 2. Conclusions Passive hepatic arterial buffer re- sponse （HABR） disappeared in some patients early after living donor liver transplantation. There were high incidences of early biliary complications and small-for size syndrome （SFSS） in these patients. Measurement of hepatic buffer response in the early stage after living donor liver tr

关 键 词：活体肝移植 小体积综合征 肝动脉缓冲效应 胆道并发症 

分 类 号：R657.3[医药卫生—外科学]