活体肝移植术中使用手术放大镜与手术显微镜行肝动脉重建的疗效差异  

Difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction inliving donor liver transplantation

作　　者：杨健 谢炎 田大治 孙晓叶 蒋文涛 Yang Jian;Xie Yan;Tian Dazhi;Sun Xiaoye;Jiang Wentao(The First Central College of Tianjin Medical University,Tianjin 300110,China)

机构地区：[1]天津医科大学一中心临床学院,300110

出　　处：《器官移植》2020年第5期584-588,共5页Organ Transplantation

基　　金：国家自然科学基金面上项目(81870444);天津市科委慢性病防治科技重大专项(17ZXMFSY00040);天津市第一中心医院春蕾计划(CL201801);天津市自然科学基金(19JCQNJC10300)。

摘　　要：目的探讨手术放大镜与手术显微镜辅助方式下行活体肝移植(LDLT)术中肝动脉重建的疗效差异。方法回顾性分析272例LDLT供、受者的临床资料。根据肝动脉重建方式不同将受者分为放大镜组(189例)和显微镜组(83例),评估两组受者手术时间、术中出血量、肝动脉重建位置、吻合口直径、术后并发症发生率、受者生存率等的差异。结果与显微镜组比较,放大镜组的总手术时间更短、肝动脉重建时间更短、术中出血量更少,差异均有统计学意义(均为P<0.001)。放大镜组及显微镜组行肝动脉重建的最常见位置均为肝右动脉,吻合口直径分别为(2.1±0.9)mm、(2.1±0.8)mm,两组比较差异无统计学意义(P>0.05)。放大镜组和显微镜组受者术后1、2、3年生存率分别为88%、86%、85%和89%、87%、86%,差异均无统计学意义(均为P>0.05)。两组受者术后并发症发生率比较,差异亦均无统计学意义(均为P>0.05)。结论LDLT术中手术放大镜下行肝动脉重建的效果及安全性并不低于手术显微镜,且手术工作量和术中出血量更少。对于经验丰富的移植外科医师,建议在放大镜辅助下行肝动脉重建操作。Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation(LDLT).Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed.According to different patterns of hepatic artery reconstruction,all recipients were divided into the magnifying glass group(n=189)and microscope group(n=83).The operation time,intraoperative blood loss,hepatic artery reconstruction site,diameter of anastomosis,incidence of postoperative complications and survival rate of recipients were statistically compared between two groups.Results Compared with the microscope group,the operation time,hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group(all P<0.001).The most common site of hepatic artery reconstruction was the right hepatic artery in two groups,and the diameter of anastomosis was(2.1±0.9)mm in the magnifying glass group and(2.1±0.8)mm in the microscope group,with no statistical significance between two groups(P>0.05).The 1-,2-and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantlydiffer from 89%, 87% and 86% in the microscope group (all P>0.05). The incidence of postoperative complications did notsignificantly differ between two groups (all P>0.05). Conclusions The efficacy and safety of hepatic artery reconstructionin LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workloadand intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic arteryreconstruction assisted by surgical magnifying glass.

关 键 词：活体肝移植 肝动脉重建 手术显微镜 手术用双目放大镜 围手术期 终末期肝病模型(MELD)评分 CHILD-PUGH分级 肝动脉血栓 

分 类 号：R617[医药卫生—外科学]