在体与离体劈离式肝移植在儿童肝移植中的应用比较  

Comparison of in vivo and in vitro split liver transplantation in pediatric liver transplantation

作　　者：刘军[1] 丘文静 孙方昊 李松盈 易述红[2] 傅斌生[2] 杨扬[2] 罗慧[1] Liu Jun;Qiu Wenjing;Sun Fanghao;Li Songying;Yi Shuhong;Fu Binsheng;Yang Yang;Luo Hui(Surgical Anesthesia Center,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Hepatobiliary Surgery and Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院手术麻醉中心,广州510630 [2]中山大学附属第三医院肝脏外科暨肝移植中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第5期688-693,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金面上项目(2022A1515012611);广东省基础与应用基础研究基金项目(区域联合基金青年基金项目)(2021A1515111153)

摘　　要：目的探讨在体和离体劈离式肝移植(SLT)围手术期手术配合管理及两种术式对儿童肝移植预后的影响。方法回顾性分析2022年3月至2023年2月在中山大学附属第三医院行SLT的30例儿童肝移植供受者临床资料。患儿或(和)家属均签署知情同意书,符合医学伦理学规定。其中男23例,女7例;年龄0~8.0岁,中位年龄2.8岁。根据术式不同分为在体劈离组(16例)和离体劈离组(14例)。比较两种术式的围手术期手术配合措施,并分析两种术式对肝移植受者早期肝肾功能及预后的影响。冷缺血时间等偏态分布数据比较采用秩和检验;两组存活率比较采用Fisher确切概率法。结果与离体劈离组相比,在体劈离组手术操作更复杂,参与手术的人员与需要的医疗设备、手术器械及耗材更多。在体劈离组中位冷缺血时间为176(149,244)min,明显少于离体劈离组的366(275,418)min,(Z=-3.576,P<0.05)。在体劈离组术后总费用为14.8(13.9,16.2)万元,明显少于离体劈离组的19.1(15.2,23.5)万元(Z=-2.079,P<0.05)。在体劈离组术后AST、ALT、Scr早期恢复更快。随访时间10~20个月,中位随访时间16个月。两组术后发生动脉栓塞各1例,在体劈离组胆漏1例;离体劈离组死亡2例。在体劈离组和离体劈离组1年存活率分别为100%(16/16)和86%(12/14),差异无统计学意义(P=0.209)。结论与离体SLT相比,在体劈离在手术人员、手术器械及耗材等各方面要求较高,但在减少肝脏冷缺血时间、肝肾功能早期恢复及降低总费用方面具有较大优势。Objective To investigate perioperative cooperation management of in vivo and in vitro split liver transplantation(SLT),and evaluate the effect of two procedures on clinical prognosis of pediatric liver transplantation.Methods Clinical data of 30 children who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from March 2022 to February 2023 were retrospectively analyzed.The informed consents of all children or(and)family guardians were obtained and the local ethical committee approval was received.Among them,23 patients were male and 7 female,aged from 0 to 8.0 years,with a median age of 2.8 years.According to different surgical procedures,all children were divided into the in vivo SLT group(n=16)and in vitro SLT group(n=14).Perioperative cooperation measures for two surgical procedures were compared.The effects of two surgical procedures upon early liver and kidney function and prognosis of liver transplantation recipients were evaluated.Skewed distribution data such as cold ischemia time were compared by rank-sum test.The survival rates between two groups were compared by Fisher's exact test.Results Compared with the in vitro SLT group,the procedures were more complicated,the number of surgeons and the amount of medical instruments,devices and consumables were higher in the in vivo SLT group.In the in vivo SLT group,the median cold ischemia time was 176(149,244)min,significantly shorter than 366(275,418)min in the in vitro SLT group(Z=-3.576,P<0.05).In the in vivo SLT group,the total postoperative expense was 14.8(13.9,16.2)×10^(4) Yuan,significantly less than 19.1(15.2,23.5)×10^(4) Yuan in the in vitro SLT group(Z=-2.079,P<0.05).In the in vivo SLT group,AST,ALT and Scr levels were recovered faster in the early stage after SLT.The follow-up time was 10-20 months,and the median follow-up time was 16 months.Postoperative arterial embolism occurred in 1 case in each group.Bile leakage occurred in 1 case in the in vivo SLT group.Two children died in the in vitro SLT group.In the in vivo SLT

关 键 词：肝移植 儿童 在体劈离式 离体劈离式 预后 

分 类 号：R726.5[医药卫生—儿科]