心脏死亡后器官捐献肝移植患者术后胆道吻合口狭窄影响因素及治疗策略  

Risk factors of biliary anastomotic stenosis after liver transplantation from donation after cardiac death and therapeutic strategies

作　　者：高杨[1] 李肖山[1] 张升宁[1] 莽源祎 任刚[1] 刘静[1] 李来邦[1] 冉江华[1] 李立[1] Gao Yang;Li Xiaoshan;Zhang Shengning;Mang Yuanyi;Ren Gang;Liu Jing;Li Laibang;Ran Jianghua;Li Li(Department of Hepatobiliary Pancreatic and Vascular Surgery,First Hospital of Kunming,The Affiliated Calmette Hospital of Kunming Medical University,Organ Transplantation Research Institute of Yunnan,Kunming 650000,China)

机构地区：[1]昆明市第一人民医院,昆明医科大学附属甘美医院肝胆胰血管外科,云南省器官移植研究所,昆明650000

出　　处：《中华肝胆外科杂志》2020年第9期678-682,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81660112)。

摘　　要：目的探讨公民心脏死亡后器官捐献(DCD)肝移植患者术后胆道吻合口狭窄并发症的相关因素及治疗策略。方法回顾分析2010年1月至2018年6月在昆明市第一人民医院接受肝移植192例患者资料,供肝均来源于DCD。共入组145例患者,男性85例,女性60例,平均年龄45岁。145例患者中发生胆道吻合口狭窄8例,无狭窄137例,比较狭窄和无狭窄患者中国分类标准、供体年龄、体质量指数、供肝脂肪样变、冷缺血时间、热缺血时间、供体非计划心脏停搏时间、供体升压药使用情况、供体高钠血症、吻合技术等相关因素与胆道吻合口狭窄的关系,并讨论其治疗策略。Spearman相关分析狭窄相关因素。结果结果提示发生狭窄情况与供体年龄(r=0.229)、体质量指数(r=0.204)、脂肪样变(r=0.239)、热缺血时间(r=0.214)、非计划心脏停搏的总时间(r=0.401)、升压药物的使用(r=0.237)和术前供体存在高钠血症(r=0.557)均呈正性相关(均P<0.05)。内镜下胆道支架置入对治疗胆道吻合口狭窄有效,成功率高。结论引起DCD肝移植患者术后胆道吻合口狭窄的相关因素较多,加强供体维护,缩短冷缺血时间、热缺血时间,提高吻合技术可以有效降低胆道并发症。内镜下放置胆道支架是治疗胆道吻合口狭窄的首选方式。ObjectiveTo investigate the related risk factors for biliary anastomotic stenosis after liver transplantation(LT)from donation after cardiac death(DCD)and therapeutic strategies.MethodsThe data of 192 patients who received LT from DCD in First Hospital of Kunming from Jan 2010 to Jun 2018 were retrospectively analyzed.A total of 145 patients were enrolled,85 males and 60 females,with average age 45 years.There was a biliary anastomotic stenosis in 8 cases and no stenosis in 137 cases.Their Chinese criterion for biliary anatomic stenosis,age,body mass index,liver fat,cold/warm ischemia time,unschedule cardiac arrest time,usage of vasopressors,high sodium in the donor were compared,and stenosis related factors were analysed by Spearman correlation analysis.ResultsThe stenosis was positively correlated with age(r=0.229),body mass index(r=0.204),lipoidosis(r=0.239),duration of hot ischemia(r=0.214),total duration of unplanned cardiac arrest(r=0.401),use of booster drugs(r=0.237),and preoperative donor hypernatremia(r=0.557)(all P<0.05).Endoscopic biliary stent implantation is effective in the treatment of biliary anastomotic stenosis and has a high success rate.ConclusionsThere are many factors related to biliary anastomotic stenosis after DCD liver transplantation,but the better donor maintenance,shorten cold/warm ischemia time,improved anastomosis will be helpful to reduce biliary complications.As the same time,endoscopic biliary stent placement is the preferred way to treat biliary anastomotic stenosis.

关 键 词：肝移植 公民心脏死亡后器官捐献 胆道吻合口狭窄 危险因素 治疗 

分 类 号：R657.3[医药卫生—外科学]