儿童肝移植术后发生早期肝动脉血栓的影响因素分析  

Analysis of influencing factors for early⁃stage hepatic artery thrombosis in pediatric liver transplantation

作　　者：胡伟 康权[1] 张明满[1] 李英存[1] 熊强[1] 邓玉华[1] 胡键阳[1] 王浩名[1] 王瑞珏[1] 韩环立[1] 乐盈 戴小科[1] Hu Wei;Kang Quan;Zhang Mingman;Li Yingcun;Xiong Qiang;Deng Yuhua;Hu Jianyang;Wang Haoming;Wang Ruijue;Han Huanli;Le Ying;Dai Xiaoke(Department of Hepatobiliary Surgery,Children′s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Stem Cell Therapy Engineering Technology Research Center,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院肝胆外科儿童发育疾病研究教育部重点实验室国家儿童健康与疾病临床医学研究中心儿童发育重大疾病国家国际科技合作基地重庆市干细胞治疗工程技术研究中心儿科学重庆市重点实验室,400014

出　　处：《中华消化外科杂志》2020年第12期1273-1279,共7页Chinese Journal of Digestive Surgery

基　　金：重庆市科委基础与前沿研究计划项目(CSTC2013jcyjA10026)。

摘　　要：目的探讨儿童肝移植术后发生早期肝动脉血栓(HAT)的影响因素。方法采用回顾性病例对照研究方法。收集2011年7月至2019年11月重庆医科大学附属儿童医院收治的93例儿童肝移植受者的临床资料;男50例,女43例;中位年龄为7个月,年龄范围为3个月至15岁;体质量为7.0 kg(6.5 kg,11.0 kg)。观察指标:(1)随访情况。(2)术后发生早期HAT及其治疗情况。(3)影响术后发生早期HAT的影响因素分析。(4)术中尿量体质量比、术中平均尿量对HAT的预测能力。采用住院、门诊、电话及微信群联系方式进行随访,了解受者术后1个月内有无早期HAT。随访时间截至2019年12月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)或M(P25,P75)表示,计数资料以绝对数表示。单因素分析采用单因素Logistic检验,不符合单因素Logistic回归条件的使用Fisher确切概率法,多因素分析采用Logistic检验。绘制受试者工作特征(ROC)曲线,计算约登指数。结果(1)随访情况:93例肝移植受者均获得随访,随访时间为1~98个月,中位随访时间为18个月。(2)术后发生早期HAT及其治疗情况:93例受者中,术后7例发生早期HAT;男1例,女6例;中位年龄为7个月,年龄范围为5个月至15岁。1例受者为二次手术后再次发生早期HAT。7例受者首次发生早期HAT时间为术后4 d(1 d,9 d)。7例受者肝移植手术时间为9.0 h(7.3 h,17.5 h)。7例受者肝动脉吻合均使用8⁃0 Prolene线,3例行连续缝合,4例行间断缝合,血管吻合直径为0.25~0.40 cm。7例受者供肝动脉选择肝总动脉4例,肝固有动脉2例,腹主动脉侧壁带腹腔干1例;7例受者动脉选择肝固有动脉3例,肝左右动脉分叉成形2例,肝右动脉1例,变异肝右动脉1例。7例受者中,5例首选血管介入溶栓治疗,2例首选肝动脉取栓及肝动脉重建;5例血管介入溶栓受者中1例溶栓后预后良好,4例溶栓后复查B超血流无明显改善,行肝动脉取�Objective To investigate the influencing factors for early⁃stage hepatic artery thrombosis in pediatric liver transplantation.Methods The retrospective case⁃control study was conducted.The clinical data of 93 pediatric recipients who underwent liver transplantation in Children′s Hospital of Chongqing Medical University from July 2011 to November 2019 were collected.There were 50 males and 43 females,aged from 3 months to 15 years,with a median age of 7 months.The body mass of 93 children was 7.0 kg(6.5 kg,11.0 kg).Observation indicators:(1)follow⁃up;(2)occurrence of early⁃stage hepatic artery thrombosis after operation and its treatment;(3)analysis of influencing factors for early⁃stage hepatic artery thrombosis after operation;(4)prediction efficiency of the ratio of volume of intraoperative urine output to body mass and the average volume of intraoperative urine output for occurrence of early⁃stage hepatic artery thrombosis.Follow⁃up using outpatient examination,telephone interview and WeChat group communication was conducted to detect occurrence of early⁃stage hepatic artery thrombosis within 1 month after operation.The follow⁃up was up to December 2019.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range)or M(P25,P75).Count data were described as absolute numbers.Univariate analysis was conducted using the Logistic test.Clinical data inconformity of Logistic test was analyzed using the Fisher exact probability.Multivariate analysis was conducted using the Logistic test.The receiver operating characteristic(ROC)curve was constructed,and the Youden index was calculated.Results(1)Follow⁃up:93 recipients undergoing liver transplantation were followed up for 1 to 98 months,with a median follow⁃up time of 18 months.(2)Occurrence of early⁃stage hepatic artery thrombosis after operation and its treatment:Of 93 cases,7 cases had early⁃stage hepatic artery thrombosis after operation including 1 male a

关 键 词：肝脏疾病 肝移植 肝动脉血栓 血管 尿量 儿童 

分 类 号：R726.5[医药卫生—儿科]