脑-心双死亡与脑死亡供肝移植的疗效比较  

Comparison of outcomes of liver transplantation using grafts from brain dead donors versus brain and cardiac dead donors

作　　者：毕方方[1] 甄作均[1] 陈焕伟[1] 吴志鹏[1] 李清汉[1] 许鹏杰 计勇[1] 胡刚[2] 

机构地区：[1]中山大学附属佛山医院佛山市第一人民医院肝脏胰腺外科,广东528000 [2]湖北省黄石市中心医院普外科

出　　处：《中华肝胆外科杂志》2015年第4期223-227,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨脑-心双死亡（DBCD）与脑死亡（DBD）不同捐献模式对肝移植疗效的影响.方法 回顾佛山市第一人民医院2011年11月至2014年7月实施的38例器官捐献成人肝移植临床资料,其中DBCD 28例、DBD 10例.分析DBCD、DBD两组受者供肝移植术中、术后情况.主要观察终点是两组术后原发性移植肝无功能、早期移植肝功能不全、胆道或肝血管早期并发症（＜30 d）的发生以及术后1年移植物和受者生存情况.结果 两组术后均未出现原发性移植肝无功能.DBCD组术后发生早期移植肝功能不全9例,胆管狭窄4例,胆漏2例,肝动脉夹层动脉瘤1例;DBD组术后发生早期移植肝功能不全2例,胆管狭窄3例.两组术后并发症发生率差异无统计学意义.DBCD组有1例因术中、术后严重凝血功能障碍出现弥散性血管内凝血（DIC）、多脏器功能衰竭而死亡.术后1年DBCD组移植物及受者生存率（95.7％）与DBD组（100％）比较差异无统计学意义（P＞0.05）.结论 DBCD供肝移植疗效良好,可取得与DBD供肝移植类似的效果.Objective To analyze the outcomes of liver transplantation using grafts from brain dead donors versus brain and cardiac dead donors.Methods 38 patients who underwent adult to adult liver transplantation in our hospital from November 2011 to July 2014 were retrospectively studied.28 patients received liver grafts from brain and cardiac dead donors （DBCD） and 10 patients received liver grafts from brain dead donors （DBD）.The intraoperative and postoperative results were compared between the two groups.The primary endpoint of this study was primary non-functioning of liver graft.The secondary endpoints were initial poor graft functioning,early bile duct and hepatic vascular complications within 30 days of operation.The 1-year graft and patient survival rates were also compared.Results There was no primary non-functioning of the liver graft in the two groups.In the DBCD group,there were 9 patients who developed initial poor functioning of the grafts.In addition,biliary strictures developed in 4 patients,biliary leak in two and hepatic artery dissection aneurysm in one.For the DBD group,there were two patients with initial poor functioning of liver grafts and 3 patients with biliary strictures.They were no significant significance in these complications between the 2 groups.One recipient in the DBCD group who died as a result of severe coagulation dysfunction,disseminated intravascular coagulation which progressed to multiple organ failure.The 1-year graft and patient survival for the DBCD and the DBD groups were 95.7％,100％ respectively,with no significant difference between the two groups.Conclusion The outcomes of liver recipients using liver grafts from DBCD were similar to DBD.

关 键 词：脑死亡 脑-心双死亡 器官捐献 肝移植 

分 类 号：R657.3[医药卫生—外科学]