尸体供肝移植术后被动肝动脉缓冲效应的相关研究  

Study on passive hepatic arterial buffer response after liver transplantation

作　　者：钱道海[1] 沈柏用[1] 彭承宏[1] 陶然[1] 祝哲诚[1] 邓侠兴[1] 程东峰[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肝胆胰外科及肝移植中心,上海200025

出　　处：《上海交通大学学报（医学版）》2012年第6期771-774,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科委课题资助(09411952100)~~

摘　　要：目的探讨肝移植术后(被动)肝动脉缓冲效应(HABR)与肝功能恢复及早期胆道并发症的关系。方法对60例尸体供肝移植受者术前及术后1、2 d的肝动脉和门静脉血流量进行监测,评估HABR。根据评估结果将患者分为存在(被动)HABR组(HABR组)和(被动)HABR受损(减弱或消失)组(No-HABR组),结合肝功能、B超及经内镜逆行胰胆管造影(ERCP)检查结果,分析HABR与移植术后肝功能恢复和早期胆道并发症的关系。结果 60例尸体供肝移植受者分入HABR组和No-HABR组各30例。与No-HABR组比较,HABR组患者肝功能恢复时间和总住院时间明显缩短(P<0.05),谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBIL)等肝功能指标恢复显著(P<0.05)。HABR组患者的早期胆道并发症发生率显著低于No-HABR组(P<0.05)。结论尸体供肝移植术后,可通过监测肝动脉和门静脉流量的变化评估HABR,完善的(被动)HABR可促进患者肝功能恢复并降低早期胆道并发症的发生率。Objective To investigate the association of passive hepatic arterial buffer response（HABR） with recovery of liver function and early biliary complications after liver transplantation.Methods The early hepatic arterial flow and portal venous flow were monitored in 60 patients subject to liver transplantation before operation and 1 d and 2 d after operation,and HABR was evaluated.According to HABR findings,patients were divided into HABR group（HABR existence） and No-HABR group（HABR impairment）.Based on results of liver function tests,B ultrasonography and endoscopic retrograde cholangio-pancreatography（ERCP）,the association of HABR with recovery of liver function and early biliary complications after liver transplantation was analysed.Results There were 30 patients in HABR group and No-HABR group each.The time of recovery of liver function and duration of hospital stay in HABR group were significantly shorter than those in No-HABR group（P〈0.05）,and the liver function parameters of alanine aminotransferase（ALT）,aspartate aminotransferase（AST） and total bilirubin（TBIL） in HABR group were better recovered（P〈0.05）.The prevalence of early biliary complications in HABR group was significantly lower than that in No-HABR group（P〈0.05）.Conclusion HABR can be evaluated by monitoring of hepatic arterial flow and portal venous flow after liver transplantation,and the intact passive HABR may promote recovery of liver function and decrease the prevalence of early biliary complications.

关 键 词：肝移植 肝动脉缓冲效应 被动 血流动力学 肝功能 早期胆道并发症 

分 类 号：R657.3[医药卫生—外科学]