肝动脉重建技术对肝移植预后的影响  

Effect of hepatic artery reconstruction techniques on prognosis of liver transplantation

作　　者：李欣澄 黄帆[1] 王国斌[1] 余孝俊[1] 吴若林[1] 侯刘进 叶征辉 张兴华 王伟[1] 耿小平[1] 赵红川[1] Li Xincheng;Huang Fan;Wang Guobin;Yu Xiaojun;Wu Ruolin;Hou Liujin;Ye Zhenghui;Zhang Xinghua;Wang Wei;Geng Xiaoping;Zhao Hongchuan(Organ Transplantation Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院器官移植中心,合肥230022

出　　处：《器官移植》2023年第1期128-134,共7页Organ Transplantation

基　　金：安徽省自然科学基金青年基金项目(2008085QH361)。

摘　　要：目的探讨肝动脉不同重建方式对肝移植术后肝动脉并发症和预后的影响。方法回顾性分析140例肝移植受者的临床资料,根据肝动脉重建方式分为常规类型肝动脉重建组(123例)及特殊类型肝动脉重建组(17例),比较两组受者术中和术后的各项临床指标以及术后肝动脉并发症发生率和生存率。结果特殊类型肝动脉重建组术后1 d丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)、术后7 d总胆红素(TB)、术后30 d凝血酶原时间国际标准化比值(PT-INR)均高于常规肝动脉重建组,差异均有统计学意义(均为P<0.05)。两组的手术时间、无肝期、术中失血量、术中输入红细胞量、冷或热缺血时间、重症监护室(ICU)入住时间、总住院时间、术后移植肝血流情况差异均无统计学意义(均为P>0.05)。常规组发生肝动脉并发症5例,而特殊组未见肝动脉并发症,两组比较差异无统计学意义(P>0.05)。特殊类型肝动脉重建组术后1、3、5年累积生存率均为82.4%,常规重建组术后1、3、5年累积生存率分别为85.0%、78.9%、75.6%,两组术后生存率差异均无统计学意义(均为P>0.05)。结论当供受者肝动脉存在变异和(或)病变时,采用特殊方法行肝动脉重建可有效恢复移植肝动脉血流,并不会影响肝移植受者术后肝动脉并发症的发生率和生存率。Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation.Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed.All recipients were divided into the conventional hepatic artery reconstruction group(n=123)and special hepatic artery reconstruction group(n=17)according to hepatic artery reconstruction methods.Intraoperative and postoperative clinical indexes,the incidence of postoperative hepatic artery complications and survival rate were compared between two groups.Results The alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels at postoperative 1 d,total bilirubin(TB)at postoperative 7 d and prothrombin time international normalized ratio(PTINR)at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group,and the differences were statistically significant(all P<0.05).There were no significant differences in the operation time,anhepatic phase,intraoperative blood loss,intraoperative transfusion volume of red blood cells,cold or warm ischemia time,the length of intensive care unit(ICU)stay,the length of hospital stay and postoperative blood flow of liver allograft between two groups(all P>0.05).In the conventional hepatic artery reconstruction group,5 recipients developed hepatic artery complications,whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group,with no significant difference between two groups(P>0.05).In the special hepatic artery reconstruction group,the 1-,3-and 5-year cumulative survival rates were equally 82.4%,compared with 85.0%,78.9%and 75.6%in the conventional hepatic artery reconstruction group,respectively.There was no significant difference between two groups(all P>0.05).Conclusions When hepatic artery variations and(or)lesions are detected in donors and recipients,use of special hepatic artery r

关 键 词：肝移植 肝动脉重建 肝动脉并发症 重症监护室 总胆红素 丙氨酸转氨酶 天冬氨酸转氨酶 凝血酶原时间国际标准化比值 

分 类 号：R617[医药卫生—外科学] R619[医药卫生—临床医学]