原位肝移植术后早期肝功能不全的相关危险因素分析  

Analysis of risk factors of early allograft dysfunction after orthotopic liver transplantation

作　　者：苏洋 丁佑铭[1] 汪斌[1] 陈辰[1] 赵凯亮[1] 吴英珂 熊豪 Su Yang;Ding Youming;Wang Bin;Chen Chen;Zhao Kailiang;Wu Yingke;Xiong Hao(Department of Hepatobiliary Surgery,Renmin Hospital,Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肝胆腔镜外科,湖北武汉430060

出　　处：《腹部外科》2022年第1期37-41,共5页Journal of Abdominal Surgery

基　　金：国家十二五科技支撑计划项目(2012BAD31B08)。

摘　　要：目的分析原位肝移植术后早期肝功能不全(early allograft dysfunction,EAD)的发生情况,并探讨EAD发生的相关危险因素。方法回顾性分析武汉大学人民医院2016年1月至2020年12月实施的74例原位肝移植病人的临床资料,对可能导致术后EAD的围手术期相关因素进行单因素分析,然后将有显著性差异的因素纳入Logistic回归多因素分析。结果74例肝移植病人术后EAD的发生率为36.5%(27/74)。单因素分析结果显示,受者术前中性粒细胞与淋巴细胞比值(NLR)、术前血清总胆红素、术中失血量、术前肝功能Child-Pugh分级C级、术前终末期肝病模型(MELD)评分≥18分及术后出现胆道及血管并发症是EAD发生的潜在危险因素(均P<0.05);多因素Logistic回归分析结果显示,肝移植术后EAD的独立危险因素为:术前MELD评分≥18分[OR=0.045,95%CI(0.003,0.605),P=0.045];移植术后出现胆道及血管并发症[OR=0.061,95%CI(0.009.0.419),P=0.004]。结论术前MELD评分≥18分及术后出现胆道及血管并发症是影响肝移植术后EAD的独立危险因素。临床上应该通过改善受者术前较差的肝功能和提高临床医师手术技巧来降低EAD的发生率。Objective To examine the occurrence of early allograft dysfunction(EAD)after orthotopic liver transplantation and explore the related risk factors for the occurrence of EAD.Methods Clinical data were retrospectively reviewed for 74 orthotopic liver transplantation patients from January 2016 to December 2020.Univariate analysis was performed on perioperative related factors potentially leading to postoperative EAD.And then factors with significant differences were included for Logistic regression multivariate analysis.Results The incidence of EAD after liver transplantation was 36.5%(27/74).Univariate analysis showed that preoperative neutrophil-lymphocyte ratio(NLR),preoperative serum total bilirubin,intraoperative volume of blood loss,preoperative Child-Pugh grade C,MElD score≥18 and postoperative biliary and vascular complications were the potential risk factors for EAD(all P<0.05).Multivariate Logistic regression analysis showed that the independent risk factors for EAD after liver transplantation included preoperative liver function MELD score≥18 points[OR=0.045,95%CI(0.003,0.605),P=0.045]and biliary tract and vascular complications after transplantation[OR=0.061,95%CI(0.009.0.419),P=0.004].Conclusion Preoperative liver function MELD score≥18 and postoperative biliary and vascular complications are independent risk factors for the occurrence of EAD.Clinically,the incidence of EAD may be lowered by improving poor preoperative liver function of recipients and enhancing the surgical skills of clinicians.

关 键 词：原位肝移植 早期肝功能不全 危险因素 

分 类 号：R575[医药卫生—消化系统]