间置血管重建门静脉对儿童肝移植受者术后门静脉并发症的影响  

Lowering the incidence of complications of portal vein through vascular graft interposition during pediatric transplantation

作　　者：陈孝杰 朱志军[1] 孙丽莹[2] 张海明 魏林[1] 曲伟[1] 曾志贵[1] 刘颖[1] 张晋平 Chen Xiaojie;Zhu Zhijun;Sun Liying;Zhang Haiming;Wei Lin;Qu Wei;Zeng Zhigui;Liu Ying;Zhang Jinping(Liver Transplantation Center,National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Clinical Center for Pediatric Liver Transplantation,Capital Medical University,Beijing 100050,China;Intensive Care Unit,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科肝脏移植中心,国家消化系统疾病临床医学研究中心,首都医科大学儿童肝脏移植临床诊疗与研究中心,100050 [2]首都医科大学附属北京友谊医院重症医学科,100050

出　　处：《中华器官移植杂志》2021年第10期587-592,共6页Chinese Journal of Organ Transplantation

基　　金：首都卫生发展科研专项(首发2020-1-2024)。

摘　　要：目的探究使用左侧移植物的儿童肝移植手术中,使用间置血管重建门静脉对术后门静脉并发症的影响。方法收集首都医科大学附属北京友谊医院2013年6月1日至2018年5月31日行肝移植的儿童受者信息,包括年龄、性别、身高、体重、原发病、Child评分、腹部手术史,是否跨血型移植、术前门静脉口径、门静脉血流方向、供肝来源、移植手术日期、供肝冷缺血时间、移植物类型、门静脉重建方式、使用间置血管类型、手术时间、门静脉阻断时间、术中失血、术后门静脉并发症发生情况等临床资料。研究共纳入297例儿童受者,中位年龄12个月,男性153例(51.5%),女性144例(48.5%),原发病以胆道闭锁为主(222例,74.7%)。门静脉直径中位数5 mm。单因素分析后行二元Logistic回归分析,分析术后门静脉并发症的危险因素中是否使用间置血管;再按照是否使用间置血管分组,分析使用间置血管重建门静脉对术后门静脉并发症的发生是否存在影响。结果使用间置血管重建门静脉19例(6.4%),其中尸体冷保存血管16例,儿童受者自身门静脉3例;供者门静脉与受者门静脉主干、分叉部或汇合部等直接吻合等未使用间置血管儿童受者278例(93.6%)。随访中位时间3.1年,共有20例儿童受者术后发生门静脉并发症,其中门静脉狭窄17例(5.7%),门静脉血栓3例(1.0%)。多因素分析结果表明受者门静脉直径是门静脉并发症发生的独立危险因素,而使用间置血管并非独立危险因素。进一步选取门静脉直径≤4 mm儿童受者90例统计分析,使用间置血管与否,对肝移植术后门静脉并发症发生率并无影响(χ^(2)=3.061,P=0.080)。结论门静脉直径是影响儿童肝移植术后门静脉并发症发生的独立危险因素,也是影响是否使用间置血管的重要因素。在门静脉直径≤4 mm时,使用间置血管不会增加术后门静脉并发症的发生率。Objective To explore the feasibility of using vascular graft interposition for lowering the complications of portal vein during pediatric liver transplantation.Methods From June 1,2013 to May 31,2018,clinical data were collected for 297 children undergoing liver transplantation,including basic demographics,general preoperative status,preoperative tests,imaging findings,graft related profiles,surgical procedures and postoperative follow-ups,etc.Then the authors analyzed the effect of using interposition vessels upon lowering postoperative complications of portal vein reconstruction.Results With a median age of 12 months,there were 153 boys(51.5%)and 144 girls(48.5%).The primary disease was mostly biliary atresia(n=222,74.7%).The median diameter of portal vein was 5 mm.There were 19 cases(6.4%)using vascular interposition.Among 20 cases of portal vein complications,there were portal vein stenosis(n=17,5.7%)and portal vein thrombosis(n=3,1.0%).After univariate analysis,binary Logistic regression analysis revealed that diameter of recipient's portal vein was an independent risk factor for the occurrence of portal vein complications after liver transplantation.Statistical analysis of children with portal vein diameter<4 mm(n=90)was carried on and the results showed that there was no inter-group statistical difference(χ^(2)=3.061,P=0.080)on the occurrence of portal vein complications.Conclusions Diameter of portal vein is an important factor affecting the strategic choice of portal vein reconstruction during pediatric liver transplantation and an independent risk factor for portal vein complications after liver transplantation.When the diameter of portal vein is≤4 mm,using interposition vascular anastomosis shows no significant difference with other conventional modes.

关 键 词：门静脉并发症 北京友谊医院 移植物 门静脉血流 直接吻合 分叉部 门静脉阻断 血管重建 

分 类 号：R726.5[医药卫生—儿科]