胰腺移植术后早期移植胰腺血栓形成的危险因素分析  

Risk factors for early pancreatic thrombosis after pancreatic transplantation

作　　者：李美思 董建辉 乔鹏飞 吴基华[1] 秦科[1] 蓝柳根[1] 雷志影 王洪良 孙煦勇 Li Meisi;Dong Jianhui;Qiao Pengfei;Wu Jihua;Qin Ke;Lan Liugen;Lei Zhiying;Wang Hongliang;Sun Xuyong(Transplant Medical Center of The Second Affiliated Hospital of Guangxi Medical University,Guangxi Clinical Research Center for Organ Transplantation,Guangxi Key Laboratory of Organ Donation and Transplantation,Nanning 530007,Guangxi,China;Department of Organ Transplantation,923 Hospital of the Joint Service Support Force of the Chinese people's Liberation Army,Nanning 530000,Guangxi,China)

机构地区：[1]广西医科大学第二附属医院移植医学中心,广西器官移植临床医学研究中心,广西器官捐献与移植研究重点实验室,广西南宁530007 [2]中国人民解放军联勤保障部队第九二三医院器官移植科,广西南宁530000

出　　处：《实用器官移植电子杂志》2023年第6期545-550,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：广西壮族自治区卫计委自筹经费课题(Z20201255);广西高校中青年教师科研基础能力提升项目(2022KY0077)。

摘　　要：目的评估胰腺移植术后早期血栓形成的危险因素。方法选取2015年1月至2019年8月中国人民解放军联勤保障部队第九二三医院46例脑死亡器官捐献(donation after brain death,DBD)供体同期胰肾联合移植(simultaneous pancreas-kidney transplantation,SPK)受者及2019年11月至2023年7月在广西医科大学第二附属医院30例DBD供体SPK受者,根据是否发生血栓分为血栓组及无血栓组。对两组受者进行回顾性研究,评估供受体的特征与胰腺移植术后早期血栓形成的危险因素。结果供受体年龄增加与胰腺血栓形成关系不大(P>0.05),受体体重指数(body mass index,BMI)与移植胰腺血栓形成关系密切(P=0.01),胰腺外分泌液引流选择方式对移植胰腺血栓关系不大(P=0.49),采用动脉或静脉来延长供胰静脉与胰腺移植术后血栓形成有关(P=0.02),接受肝素后序贯用阿司匹林比单用阿司匹林的受者血栓形成的发生率较低(P=0.04)。供者淀粉酶的变化是移植胰腺血栓形成的危险因素(P=0.04),受者术后第7天D二聚体(D-dimer,D-D)的变化提示移植胰腺血栓的形成。结论受者BMI、动脉或静脉延长供胰静脉、是否使用肝素、供体淀粉酶变化是胰腺移植术后早期血栓形成的危险因素。Objective To assess the risk factors for early thrombosis after pancreatic transplantation.Methods We selected 46 recipients of simultaneous pancreas-kidney transplantation(SPK) from donation after brain death(DBD) donors in the 923 Hospital of the People's Liberation Army Joint Support Force from January 2015 to August 2019,and 30 SPK recipients of DBD donors in the Second Affiliated Hospital of Guangxi Medical University from November 2019 to July 2023 were collected.They were divided into thrombotic group and non thrombotic group based on whether thrombosis had occurred.A retrospective study was conducted on two groups of recipients to evaluate the characteristics of donors and recipients and the risk factors for early thrombosis after pancreatic transplantation.Results The age of the donor and recipient was not significantly related to pancreatic thrombosis(P > 0.05).The recipient body mass index(BMI) was closely related to the formation of transplanted pancreatic thrombosis(P = 0.01).The choice of drainage method for pancreatic exocrine fluid had little effect on transplanted pancreatic thrombosis(P = 0.49).The use of arteries or veins to extend the donor pancreatic vein was associated with thrombosis after pancreatic transplantation(P = 0.02).The incidence of thrombosis in recipients who received heparin and received sequential aspirin was lower than those who received aspirin alone(P = 0.04).The change of donor amylase was a risk factor for pancreatic graft thrombosis(P = 0.04).The change of D-dimer(D-D) on the 7th day after surgery in the recipient suggested the formation of transplanted pancreatic thrombosis.Conclusion The recipient's BMI,arterial or venous extension of the donor pancreatic vein,use of heparin,and changes in donor amylase are risk factors for early thrombosis after pancreatic transplantation.

关 键 词：胰腺移植 胰肾联合移植 血栓 

分 类 号：R657.5[医药卫生—外科学]