离体肝脏冷缺血时间对自体肝移植术后早期肝脏功能及并发症影响研究  

Effects of cold ischemia time of isolated liver on early liver function and complications after liver autotransplantation

作　　者：卡地尔丁·艾海提 叶建荣[1,3] 吐尔干艾力·阿吉 Kadierding·Aihaiti;YE Jian-rong;Tuerganaili·Aji(Department of Anesthesiology the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Perioperative Organ Protection Laboratory(XJDX1411),Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830011 [2]新疆医科大学第一附属医院肝胆包虫外科,新疆乌鲁木齐830011 [3]新疆围手术期器官保护实验室(XJDX1411),新疆乌鲁木齐830011

出　　处：《中国实用外科杂志》2023年第3期315-318,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.82060581,No.8196080421)。

摘　　要：目的 探讨离体肝脏冷缺血时间(CIT)对自体肝移植术后早期肝脏功能及并发症的影响。方法 回顾性分析2017年12月至2020年11月在新疆医科大学第一附属医院接受自体肝移植的89例病人资料,根据术中离体肝脏冷缺血时间长短将病人分为A组(CIT≤6 h)和B组(CIT>6 h),比较两组病人术后早期肝功能及早期并发症的发生率。结果 A组病人术后住院天数,术后带引流管时间,术后天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)降至正常范围的时间。术后大量腹腔积液发生率,术后血管并发症的发生率,术后胆道并发症的发生率均短/低于B组病人[(20.56±9.67)d vs.(30.58±22.81)d,(14.18±6.51)d vs.(23.78±20.61)d,(7.00±2.84)d vs.(9.22±4.66)d,(8.41±2.45)d vs.(10.60±5.20)d,(10.68±5.81)d vs.(15.00±9.76)d,(10.12±5.85)d vs.(14.69±9.48)d,17.65%(6/34)vs.43.64%(24/55),2.95%(1/34)vs.21.82%(12/55),14.71%(5/34)vs.36.36%(20/55)],差异均有统计学意义(均P<0.05)。两组病人术后住ICU天数,术后AST、ALT、TBIL、DBIL峰值和达到峰值的时间,术后腹腔感染的发生率差异均无统计学意义(均P>0.05)。结论 自体肝移植术中肝脏CIT>6 h时,病人术后的总住院天数,术后带引流管时间,术后AST、ALT、TBIL、DBIL降至正常范围的时间延长,术后大量腹腔积液发生率,术后血管并发症的发生率,术后胆道并发症的发生率增高。Objective To investigate the effect of cold ischemia time(CIT)of isolated liver on the early liver function and complications after liver auto-transplantation.Methods 89 patients who received autologous liver transplantation in the First Affiliated Hospital of Xinjiang Medical University from December 2017 to November 2020 were selected.The patients were divided into group A(CIT≤6 h)and group B(CIT>6 h)according to the length of cold ischemia of the isolated liver during the operation,and the incidence of early rising liver function and early rising complications were compared between the two groups.Results Postoperative hospital stay,postoperative time with a tube,postoperative time of AST,ALT,TBIL,and BIL falling to the normal range,postoperative incidence of massive ascites,the postoperative incidence of vascular complications,and postoperative incidence of biliary complications in group A were all short/lower than those in group B[(20.56±9.67)d vs.(30.58±22.81)d,(14.18±6.51)d vs.(23.78±20.61)d,(7.00±2.84)d vs.(9.22±4.66)d,(8.41±2.45)d vs.(10.60±5.20)d,(10.68±5.81)d vs.(15.00±9.76)d,(10.12±5.85)vs.(14.69±9.48)d,17.65%(6/34)vs.43.64%(24/55),2.95%(1/34)vs.21.82%(12/55),14.71%(5/34)vs.36.36%(20/55)],the differences were statistically significant(all P<0.05).There was no significant difference between the two groups in the number of days in ICU,the peak value and time of reaching the peak value of AST,ALT,TBIL,and DBIL,and the incidence of postoperative abdominal infection(all P>0.05).Conclusion When CIT>6 h during liver autotransplantation,postoperative hospital stay,postoperative tube holding time,postoperative AST,ALT,TBIL,DBIL reduced to normal range longer;The incidence of postoperative massive ascites,and postoperative vascular complications and postoperative biliary complications increased.

关 键 词：自体肝移植 离体肝脏冷缺血时间 肝脏功能 血管并发症 胆道并发症 围手术期管理 

分 类 号：R6[医药卫生—外科学]