公民逝世后器官捐献肝移植发生肝动脉并发症的影响因素分析  

Analysis of influencing factors for hepatic artery complications of liver transplantation from donation after citizen's death

作　　者：曹阳 张洪涛 彭伟 汪建林 蒋子剑 陶开山 杨诏旭 Cao Yang;Zhang Hongtao;Peng Wei;Wang Jianlin;Jiang Zijian;Tao Kaishan;Yang Zhaoxu(Department of Hepatobiliary Surgery,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院肝胆外科,西安710032

出　　处：《中华消化外科杂志》2021年第10期1055-1060,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金项目(81970566)。

摘　　要：目的探讨公民逝世后器官捐献(DCD)肝移植发生肝动脉并发症的影响因素。方法采用回顾性队列研究方法。收集2015年1月至2020年6月空军军医大学西京医院收治的147例行DCD肝移植受者的临床病理资料;男109例,女38例;年龄为(46±12)岁。所有受者行DCD肝移植。观察指标:(1)手术情况。(2)肝移植后肝动脉并发症发生情况。(3)肝移植后发生肝动脉并发症的供者相关影响因素分析。(4)肝移植后发生肝动脉并发症的受者相关影响因素分析。(5)随访情况。采用门诊或电话方式进行随访,了解受者术后生存情况。随访时间截至2021年6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)表示。单因素分析采用Fisher确切概率法,多因素分析采用COX回归分析。采用Kaplan-Meier方法计算累积生存率和绘制生存曲线。结果(1)手术情况:147例受者中,行经典原位肝移植108例,行原位背驮式肝移植39例。147例受者手术时间为(458±101)min。(2)肝移植后肝动脉并发症发生情况:147例受者中,4例发生肝动脉并发症,其中3例为肝动脉栓塞,1例为肝动脉狭窄;并发症发生时间为肝移植后(5±2)d。(3)肝移植后发生肝动脉并发症的供者相关影响因素分析:单因素分析结果显示年龄、动脉粥样硬化、脂肪肝、动脉变异不是影响肝移植后发生肝动脉并发症的供者相关因素(P>0.05)。(4)肝移植后发生肝动脉并发症的受者相关影响因素分析:多因素分析结果显示受者肝动脉血流不足是影响肝移植后发生肝动脉并发症的独立危险因素(风险比=10.13,95%可信区间为1.05~97.42,P<0.05)。(5)随访情况:147例受者中,146例获得随访,随访时间为1~77个月,中位随访时间为34个月。146例受者1年累积生存率为92.2%。结论受者肝动脉血流不足是影响DCD肝移植发生肝动脉并发症的独立危险因素。Objective To investigate the influencing factors for hepatic artery complica-tions of liver transplantation from donation after citizen's death.Methods The retrospective cohort study was conducted.The clinicopathological data of 147 recipients who underwent liver transplan-tation from donation after citizen's death in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2020 were collected.There were 109 males and 38 females,aged(46±12)years.All recipients underwent liver transplantation from donation after citizen's death.Observation indicators:(1)surgical situations;(2)occurrence of hepatic artery complications after liver transplantation;(3)analysis of donor related influencing factors for hepatic artery complications after liver transplantation;(4)analysis of recipient related influencing factors for hepatic artery complications after liver transplantation;(5)follow-up.Follow-up was conducted using outpatient examination or telephone interview to detect survival of recipients up to June 2021.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Univariate analysis was conducted using the Fisher exact probability,and multivariate analysis was conducted using the COX regression model.Kaplan-Meier method was used to calculate the cumulative survival rate and draw the survival curve.Results(1)Surgical situations:of the 147 recipients,108 cases underwent orthotopic liver transplantation,and 39 cases underwent piggyback liver transplantation.The operation time of 147 recipients was(458±101)minutes.(2)Occurrence of hepatic artery complications after liver transplantation:4 of the 147 recipients had hepatic artery complications,including 3 cases with hepatic artery embolism and 1 case with hepatic artery stenosis.The time to occurrence of hepatic artery complications after liver transplantation was(5±2)days.(3)Analysis of donor related influencing factors for hepatic artery complications after live

关 键 词：终末期肝病 肝移植 公民逝世后器官捐献 肝动脉血栓 肝动脉狭窄 影响因素 

分 类 号：R657.3[医药卫生—外科学]