肝移植术后缺血型胆道病变发生危险因素分析  

Risk factors of ischemia-type biliarylesions in recipients of liver transplantation

作　　者：罗羽鸥 杨晓玲[1] 李川[1] Luo Yuou;Yang Xiaoling;Li Chuan(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西医院肝脏外科,成都市610041

出　　处：《实用肝脏病杂志》2020年第3期439-442,共4页Journal of Practical Hepatology

基　　金：四川省科技厅科研基金资助项目(编号:2019YJ0149)。

摘　　要：目的探讨肝移植术后缺血型胆道病变(ITBL)发生的危险因素。方法2015年1月~2019年2月我院收治的接受肝移植术治疗患者312例,根据肝功能、胆道造影和影像学检查结果诊断术后ITBL的发生,采用单因素和多因素Logistic回归分析。结果本组312例接受肝移植术患者原发疾病以原发性肝癌为主(占45.8%),术后发生ITBL者37例(11.9%);经Logistic回归分析显示输入血浆的量(OR=1.2,P=0.01)、术后1周肝动脉阻力指数(RI,OR=8.9,P=0.03)、急性排斥反应(OR=7.0,P=0.02)、冷缺血时间≥11.5 h(OR=1.1,P=0.01)为影响患者发生ITBL的独立影响因素。结论肝移植术后患者易发生ITBL,需针对诱发因素给予针对性的预防处理,以提高肝移植效果。Objective The aim of this study was to investigate the risk factors of ischemia-type biliary lesions(ITBL)in recipients of liver transplantation(LT).Methods 312 patients with terminal benign and malignant liver diseases including 143 patients(45.8%)with primary liver cancer were recruited in our hospital between January 2015 and February 2019,and the ITBL was diagnosed according to the results of liver functions,cholangiography and imaging after LT.The clinical characteristics of ITBL in patients after LT were analyzed by donor and recipient-related clinical data,and univariate and multivariate Logistic regression analysis were performed.Results Postoperative ITBL occurred in 37 cases(11.9%),and 19(51.4%)of them belonged to extrahepatic bile duct lesions;the Logistic regression analysis showed that the amount of infusion plasma(OR=1.175,P=0.006),the 1-week resistive index of hepatic artery(OR=8.891,P=0.030),acute rejection(OR=7.022,P=0.022),and cold ischemia time≥11.5 h(OR=1.055,P=0.014)were the independent factors led to ITBL occurrence.Conclusion The recipients of LT are prone to developing ITBL,and the clinicians should take the common induced factors into consideration and deal with appropriately in time to achieve an optimal efficacy.

关 键 词：肝移植术 缺血型胆道病变 肝动脉阻力指数 急性排斥反应 多因素回归分析 危险因素 

分 类 号：R657.3[医药卫生—外科学]