儿童减体积左外叶活体肝移植疗效的回顾性分析  

Efficacy analysis of reduced left lateral segment graft during pediatric living donor liver transplantation

作　　者：张国锋 董冲[1] 孙超[1] 王凯[1] 覃虹[1] 韩潮[1] 郑卫萍[1] 杨洋[1] 张复波[1] 高伟[1] Zhang Guofeng;Dong Chong;Sun Chao;Wang Kai;Qin Hong;Han Chao;Zheng Weiping;Yang Yang;Zhang Fubo;Gao Wei(Department of Children's Organ Transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院儿童器官移植科,300192

出　　处：《中华器官移植杂志》2021年第11期657-662,共6页Chinese Journal of Organ Transplantation

摘　　要：目的探讨儿童减体积左外叶活体肝移植的疗效。方法选择2014年1月至2019年12月天津市第一中心医院儿童器官移植科67例1岁以内的儿童受者接受减体积左外叶活体肝移植(RLLS组), 回顾性分析这些受者的临床资料, 比较其与左外叶活体肝移植受者(LLS组)基本资料、术后主要并发症以及术后受者、移植物存活率的差异;按移植物受者体重比率(GRWR)是否超过4%进行分组, 比较两组术后主要并发症及受者、移植物存活率的差异。结果减体积左外叶组受者年龄、身高、体重显著低于对照组(P<0.05), 供者体重、供者体重指数(BMI)、拟供肝体积、供肝脂肪肝比例显著高于对照组(P<0.05), 受者手术时长、术中失血量、输红细胞量显著高于对照组(P<0.05);术后中位住院时间、ICU停留时间、术后呼吸机支持时间两组差异无统计学意义, 术后肝动脉血栓、门静脉狭窄、胆管并发症等主要外科并发症发生率两组间差异无统计学意义(P>0.05);减体积左外叶组受者和移植物术后1年、3年累积存活率分别为92.5%、91.2%和92.5%、91.2%, 对照组受者和移植物术后1年、3年累积存活率分别为96.3%、95.3%和95.9%、95.1%, 两组间比较差异没有统计学意义(P>0.05);GRWR>4%组术后肝静脉狭窄率显著高于对照组(P<0.05)。结论由于技术的进步, 减体积左外叶儿童活体肝移植取得了满意的疗效, 是否实施减体积手术需根据术中供、受者匹配情况以及肝脏血流情况综合判断, GRWR>4%并不是绝对的实施标准。Objective To explore the efficacy of reduced left lateral segment graft during pediatric living donor liver transplantation.Methods From January 2014 to December 2019,67 children aged under 1 year underwent living donor liver transplantation with reduced left lateral segment graft(RLLS group).Clinical data were analyzed retrospectively and compared with those of left lateral segmentgraft living donor liver transplantation(LLS group).The differences in basic profiles,postoperative complications and postoperative patient/graft survival rate were compared.They were divided into two groups according to whether graft/recipient weight ratio(GRWR)was more than 4%.And major postoperative complications and graft/recipient survival rates were compared.Results Age,height and weight of recipients were significantly lower in RLLS group than those in control group(P<0.05).However,donor weight,donor body mass index(BMI),estimated graft volume and proportion of fatty liver from donor were significantly higher than those in control group(P<0.05).Operative duration,intraoperative blood loss and erythrocyte transfusion were significantly higher than those in control group(P<0.05).No significant inter-group differences existed in average postoperative hospital stay,intensive care unit(ICU)stay duration or postoperative ventilator use time(P>0.05);no significant inter-group difference existed in the incidence of such major surgical complications as hepatic artery thrombosis,portal vein stenosis and bile duct complications(P>0.05).The 1/3-year cumulative survival rates of postoperative patients and grafts were 92.5%,91.2%and 92.5%,91.2%in RLLS group and 96.3%,95.3%and 95.9%,95.1%in LLS group respectively.There was no significant inter-group difference(P<0.05).The rate of postoperative hepatic vein stenosis was significantly higher in GRWR>4%group than that in control group(P<0.05).Conclusions Due to a rapid progress of technology,living donor liver transplantation has achieved satisfactory outcomes in children with reduced left latera

关 键 词：肝移植 儿童 预后 

分 类 号：R726.5[医药卫生—儿科]