环状聚四氟乙烯人工血管重建肝静脉流出道在右半肝活体肝移植中的应用价值  

Application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroe-thylene vascular in right lobe living donor liver transplantation

作　　者：孙倍成 母小新 李国强 吴琛 谭忠明 Sun Beicheng;Mu Xiaoxin;Li Guoqiang;Wu Chen;Tan Zhongming(Department of Hepatobiliary Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Hepatobiliary Center,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,210008 [2]南京医科大学第一附属医院肝胆中心,210029

出　　处：《中华消化外科杂志》2021年第2期227-233,共7页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划精准医学研究重点专项(2016YFC0905900)。

摘　　要：目的探讨环状聚四氟乙烯人工血管重建肝静脉流出道在右半肝活体肝移植中的应用价值。方法采用回顾性描述性研究方法。收集2015年6月至2018年8月南京大学医学院附属鼓楼医院收治的4例和南京医科大学第一附属医院收治的17例行右半肝活体肝移植供者和对应21例受者的临床病理资料;21例供者中,男10例,女11例;中位年龄为46岁,年龄范围为35~57岁;中位体质量为64 kg,体质量范围为56~72 kg。21例受者中,男16例,女5例;中位年龄为42岁,年龄范围为21~68岁;中位体质量为63 kg,体质量范围为47~77 kg。观察指标:(1)手术及术后情况。(2)随访情况。采用门诊或电话方式进行随访,了解受者术后移植肝功能、肝癌复发、人工血管并发症、人工血管通畅性、生存等情况。随访时间截至2020年8月。受者需终生定期随访。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)表示。计数资料以绝对数或百分比表示。采用Kaplan-Meier法计算通畅率和生存率并绘制通畅率曲线和生存曲线。结果(1)手术及术后情况:21例供者手术时间为(367±72)min,供肝质量为(557±68)g,供肝质量与受者体质量比为0.89%±0.16%,住院时间为(10±2)d。21例供者术后未出现需再次手术或有创处理并发症,1例轻度胆瘘,术后留置腹腔引流管1周拔除。21例受者均顺利完成经典原位肝移植。供肝静脉流出道重建时间为(24±4)min,供肝植入时间为(326±66)min,无肝期为(42±6)min。重建肝中静脉V518支,直径为(6.1±1.3)mm,V815支,直径为(7.2±1.2)mm,肝右后下静脉10支,直径为(6.3±1.3)mm。受者术后入住重症监护室时间为(1.5±0.9)d,总住院时间为(22.6±6.7)d。21例受者中,10例术后发生并发症,其中5例术后1周发生肝功能异常(丙氨酸氨基转移酶、天冬氨酸氨基转移酶均>1000 IU/L,胆红素轻度升高),同时伴腹腔积液增加;行增强CT检查结果示供肝右前叶淤血Objective To investigate the application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver trans-plantation.Methods The retrospective and descriptive study was conducted.The clinicopatho-logical data of 4 donors and 4 recipients undergoing right lobe living donor liver transplantation in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School and 17 donors and 17 recipients undergoing right lobe living donor liver transplantation in the First Affiliated Hospital with Nanjing Medical University from June 2015 to August 2018 were collected.Of 21 donors,there were 10 males and 11 females,aged from 35 to 57 years,with a median age of 46 years.The median body mass of 21 donors were 64 kg,with a range from 56 to 72 kg.Of 21 recipients,there were 16 males and 5 females,aged from 21 to 68 years,with a median age of 42 years.The median body mass of 21 recipients were 63 kg,with a range from 47 to 77 kg.Observation indicators:(1)surgical and postoperative situations;(2)follow-up.Follow-up was conducted by outpatient examination or telephone interview to detect graft function,tumor recurrence,vascular graft complications,patency of vascular graft and survival of recipients up to August 2020.All recipients will be followed up for all their lives.Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range).Count data were represented as absolute numbers or percentages.The Kaplan-Meier method was used to calculate patency rates of hepatic vein outflow tract and survival rates to draw patency curve and survival curve.Results(1)Surgical and postoperative situations:the operation time,the weight of donor graft,graft to recipient weight ratio and duration of hospital stay of 21 donors were(367±72)minutes,(557±68)g,0.89%±0.16%and(10+2)days,respectively.No major complication requiring reoperation or intervention occurred in any of the 2

关 键 词：肝移植 人工血管 环状聚四氟乙烯 肝后下腔静脉 右半肝 

分 类 号：R657.3[医药卫生—外科学]