脑死亡后器官捐献供肝肝移植66例疗效分析  

Study of 66 liver transplantations from donation after brain death

作　　者：叶啟发[1] 张秋艳[1] 王彦峰[1] 叶少军[1] 彭贵主[1] 明英姿[2] 范晓礼[1] 钟自彪[1] 

机构地区：[1]武汉大学移植医学中心移植医学技术湖北省重点实验室武汉大学中南医院武汉大学肝胆疾病研究院,430071 [2]中南大学湘雅三医院卫生部移植医学工程技术研究中心

出　　处：《中华器官移植杂志》2017年第1期24-29,共6页Chinese Journal of Organ Transplantation

基　　金：NSFC-新疆联合基金（U1403222）

摘　　要：目的 总结脑死亡供肝肝移植的临床经验,并与国外研究相比较,分析其临床疗效、并发症与影响因素.方法 采用回顾性描述性研究方法,收集2010年6月至2013年6月脑死亡供肝肝移植的供、受者资料,查阅近年国外已发表的有较高影响力的原始文章、荟萃分析和数据报告,采用SPSS软件进行统计分析.结果 66例脑死亡供肝肝移植受者术后1年内严重并发症的发生率为21.2％,血管并发症的发生率为10.6％,胆道并发症的发生率为6.1％.受者术后1、3和5年存活率分别为83％、80％和73％,移植物存活率与受者存活率相同.与国外数据相比较,术后移植肝原发性无功能以及血管并发症发生率的差异无统计学意义（P＞0.05）,胆道并发症发生率较低（P＜0.05）,术后1、3、5年的移植物存活率的差异均无统计学意义（P＞0.05）,受者术后1年的存活率稍低（P＜0.05）,3年和5年的存活率与国外数据相比,差异无统计学意义（P＞0.05）.结论 脑死亡供肝肝移植术后受者主要并发症的发生率不高.与国外数据比较,受者远期存活率和移植物存活率均尚可,但术后1年受者存活率较低,需从供者器官维护、受者选择、手术以及术后管理等多方面加以改进.Objective To sum up the experiences in liver transplantations from donation after brain death （DBD）,and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors＇ affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar （P＞0.05） （83％,80％ and 73％ respectively）,similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center （P＜0.05）.The 3-and 5-year survival rate of recipients was also similar （P＞0.05）,though the 1-year survival rate was slightly lower （P＜ 0.05）.Conclusion These findings provide evidence that patient＇s prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.

关 键 词：肝移植 器官捐献 并发症 存活率 

分 类 号：R657.3[医药卫生—外科学]