自体门静脉血冲洗供肝在原位肝移植中的应用价值  

Application value of donor liver autologous portal venous blood rinse in orthotopic liver trans-plantation

作　　者：郭亚飞 朱泽斌 郑浩 王宁[1] 徐治军 栗雪峰 蔡伟[1] 宋瑞鹏 王继洲 尹大龙 刘连新 张树庚 Guo Yafei;Zhu Zebin;Zheng Hao;Wang Ning;Xu Zhijun;Li Xuefeng;Cai Wei;Song Ruipeng;Wang Jizhou;Yin Dalong;Liu Lianxin;Zhang Shugeng(Department of Hepatobiliary Surgery and Organ Transplantation,the First Affiliated Hospital of Univer-sity of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)肝胆外科、器官移植中心,合肥230001

出　　处：《中华消化外科杂志》2023年第2期244-250,共7页Chinese Journal of Digestive Surgery

基　　金：安徽省学术和技术带头人及后备人选科研活动经费资助项目(2020H224)。

摘　　要：目的探讨自体门静脉血冲洗供肝在原位肝移植中的应用价值。方法采用回顾性队列研究方法。收集2018年5月至2019年6月中国科学技术大学附属第一医院收治的35对行原位肝移植供者和受者的临床病理资料;35例供者,男31例,女4例;年龄为(48±9)岁;35例受者,男25例,女10例;年龄为(47±9)岁。35例受者中,16例采用自体门静脉血冲洗供肝,设为门静脉组;19例采用白蛋白冲洗供肝,设为白蛋白组。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用Fisher确切概率法。结果(1)手术情况。门静脉组和白蛋白组受者无肝期时间、开放后5 min内动脉血Ca2+浓度分别为(52±12)min、(0.99±0.10)mmol/L和(64±12)min、(1.05±0.07)mmol/L,两组上述指标比较,差异均有统计学意义(t=2.94,2.22,P<0.05);开放后5 min内平均动脉压、开放后5 min内动脉血K+浓度、开放后5 min内动脉血pH值分别为(70±24)mmHg(1 mmHg=0.133 kPa)、(4.7±1.3)mmol/L、7.27±0.06和(71±28)mmHg、(4.6±1.1)mmol/L、7.30±0.07,两组上述指标比较,差异均无统计学意义(t=0.14,0.30,1.22,P>0.05)。(2)术后情况。门静脉组和白蛋白组受者发生再灌注后综合征、严重再灌注后综合征(心脏停搏)、原发性移植物无功能分别为6、0、2例和8、1、1例,两组上述指标比较,差异均无统计学意义(P>0.05);术后第7天总胆红素分别为(90±52)μmol/L和(166±112)μmol/L,两组比较,差异有统计学意义(t=2.66,P<0.05);术后第7天国际标准化比值、术后7 d内丙氨酸转氨酶最高值、术后7 d内天冬氨酸转氨酶最高值分别为2.1±2.0、(1952±2813)IU/L、(3944±6673)IU/L和1.8±0.6、(1023±1014)IU/L、(2005±2910)IU/L,两组上述指标比较,差异均无统计学意义(t=0.66,1.23,1.08,P>0.05)。门静脉组和白蛋白组受者发生肝动脉并�Objective To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation(OLT).Methods The retrospective cohort study was conducted.The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected.Of the 35 donors,there were 31 males and 4 females,aged(48±9)years.Of the 35 recipients,there were 25 males and 10 females,aged(47±9)years.Of the 35 recipients,16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group,and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Measurement data with normal distribution were represented as Mean±SD,and compari-son between groups was analyzed using the t test.Measurement data of skewed distribution were represented as M(range).Count data were descried as absolute numbers,and comparison between groups was analyzed using the Fisher exact probability.Results(1)Surgical situations.The anhepatic phase time and arterial blood Ca2+concentration within 5 minutes after reperfusion of the recipients were(52±12)minutes and(0.99±0.10)mmol/L in the portal vein group,versus(64±12)minutes and(1.05±0.07)mmol/L in the albumin group,showing significant differences in the above indicators between the two groups(t=2.94,2.22,P<0.05).The mean arterial pressure,arterial blood K+concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were(70±24)mmHg(1 mmHg=0.133 kPa),(4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group,versus(71±28)mmHg,(4.6±1.1)mmol/L and 7.30±0.07 in the albumin group,showing no significant difference in the above indicators between the two groups(t=0.14,0.30,1.22,P>0.05).(2)Post-operative situations.Cases with post-reperfusion syndrome(PRS),cases wit

关 键 词：肝移植 供肝冲洗 再灌注后综合征 缺血再灌注损伤 缺血性胆道病 

分 类 号：R657.3[医药卫生—外科学]