奥曲肽对婴幼儿肝移植后小体积移植肝相关门静脉高灌注的调节作用  

Octreotide therapeutic strategy to attenuate portal hyperperfnsion resulted from small-for-size graft in infant liver transplantation

作　　者：王卫利[1] 高思楠[1] 康一生 刘蕾 于立新[1] 蔡金贞 高伟 刘懿禾[4] 

机构地区：[1]天津市第一中心医院移植外科,300192 [2]天津市器官移植重点实验室 [3]天津市器官移植临床医学研究中心 [4]卫生部危重病急救医学重点实验室

出　　处：《中华器官移植杂志》2017年第8期474-478,共5页Chinese Journal of Organ Transplantation

基　　金：器官移植科国家临床重点专科建设项目（201354411）

摘　　要：目的探讨奥曲肽在调节婴幼儿肝移植受者小体积移植肝相关门静脉高灌注中的作用。方法2013年12月至2016年8月共有22例婴幼儿受者植入小体积移植肝，小体积移植肝定义为移植肝体积与受者标准肝体积比（GV／SLV）〈0．5，且移植肝重量（GW）〈150g。22例受者中，12例应用奥曲肽治疗（奥曲肽组），术后每日持续静脉输注奥曲肽300gg，用药时间24-96h；余10例为早期移植病例，未给予奥曲肽干预，作为对照组。对比分析术后早期（术后7d内）两组受者门静脉血流量及血清天冬氨酸转氨酶（AST）、胆红素总量（TB）和直接胆红素（DB）等移植肝功能生化指标的变化与差异，并观察两组受者肝动脉闭塞和胆道并发症发生情况。结果奥曲肽组和对照组初始时门静脉血流量分别为（413．43±76．24）和（390．83±107．89）ml·min^-1·100g（P〉0．05），术后第3天分别为（334．90±96．67）和（441．04±117．41）ml·min^-1·100g（P〈0.05），术后第5天分别为（322．20±81．04）和（423．23±100．81）ml·min^-1·100g（P〈0.05）。两组受者术后早期各时间点血清AST、TB和DB水平的差异均无统计学意义（P〉0．05）。奥曲肽组与对照组的肝动脉闭塞发生率分别为33．33％和44．44％，胆道并发症发生率分别为33．33％和11．11％，两组间差异均无统计学意义（P〉0．05）。结论奥曲肽可以降低婴幼儿肝移植受者小体积移植肝相关的门静脉血流量，但对于术后早期移植肝功能及相关并发症的影响还有待于更大样本的研究证实。Objective To explore the effectiveness of octreotide therapeutic strategy to attenuate portal hyperperfusion resulted from small-for-size graft in infant liver transplantation. Methods A total of 22 infants received small-for-size liver graft （defined as GV/SLV〈0. 5, and GV〈150 g） in our hospital from December 2013 to August 2016. Twelve cases （octreotide group） were treated with intravenous octreotide infusion （300 g daily for 24-96 h） to attenuate the portal hyperperfusion after transplantation,and the rest 10 cases given liver transplantation at the early stage did not receive the intervention of octreotide and served as control group. Results The initial portal vein flows （PVFs） in octreotide group and control group were （413.43 ± 76. 24） （390. 83 ± 107. 89） ml/（min 100 g）, and there was no significant difference between two groups （P〉0. 05）. The PVFs on postoperative day （POD） 3 and POD5 in octreotide group and control group were （334. 90 ± 96. 67） and （441.04 ± 117.41） ,and （322. 20 ± 81.04） and （423. 23 ± 100. 81） mL/（min 100 g） respectively （P〈0. 05 for all）. However, there were no significant differences in serum AST and bilirubin levels at four time points （initial, POD3, POD5 and POD7） after transplantation between two groups （P〉0. 05）. The incidence of hepatic artery occlusion, and biliary complications in octreotide group and ontrol group was 33. 33% and 44. 44%, and 33. 33% and 11.11 % respectively （ P 〉 0. 05 for all）. Conclusion Octreotide treatment attenuated portal hyperperfusion resulted from small-for-size graft in infant liver transplantation. However, the effects of octreotide therapy on graft biochemical tests, the hepatic artery and biliary complications were still unclear, and further investigation is needed.

关 键 词：婴幼儿 肝移植 奥曲肽 门静脉高灌注 小体积供肝 

分 类 号：R726.5[医药卫生—儿科]