肝移植术中血管架桥对术后并发症及肝功能恢复的影响研究

发布时间：2018-05-26 23:18

本文选题：肝移植 + 血管架桥　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:旨在对比肝移植术中行肝动脉或门脉搭桥术与未行搭桥术的患者术后并发症(主要是血管并发症及胆道并发症)、肝功能恢复情况及生存率之间的差异。方法:选取浙江大学医学院附属第一医院2011年11月至2016年9月行肝移植术并于术中行血管架桥的患者(共计12例,其中动脉架桥7例,静脉架桥4例,动静脉均架桥1例)作为实验组,并选取浙江大学医学院附属第一医院2011年11月至2016年9月行肝移植术但未行血管架桥,且保证供肝与受体门脉主干端端吻合,受体吻合动脉比例与实验组一致者(共计33例)作为对照组。动脉、静脉搭桥组与对照组术前男女比例、年龄、是否肿瘤、血型是否相合、术前肝功能情况(包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)、白蛋白(Alb)、凝血酶原时间(PT)、Child-Pugh评分、MELD评分(小儿用PELD评分)等)、冷缺血时间、热缺血时间、无肝期、胆道吻合方式均无明显差异(p0.05)。由此分别对比两组术后血管并发症、胆道并发症情况,术后1天、3天、5天、7天及大于1月的肝动脉及门脉血流情况,术后1天、2天、3天、7天及大于1月的肝功能情况及术后至记录数据当天患者的生存情况。生存资料分析及曲线绘制采用Kaplan-Meier方法,余计数资料应用卡方检验,计量资料应用独立样本t检验。结果:术后分别比较动静脉搭桥组与未搭桥组肝功能情况,在术后1天、2天、3天、7天及大于1月的时间范围里,两组患者ALT、AST、TB、Alb、PT均无明显差异(p0.05);对比动脉搭桥组与未搭桥组术后1天、3天、5天、7天及大于1月的左、右肝动脉阻力指数(RI)及血流峰值,得到在术后第1天动脉搭桥组左右肝动脉RI显著大于对照组(p0.05),在术后第7天左右肝动脉RI均显著小于对照组(p0.05),而两组在肝动脉峰值流速的比较中无显著性差异(p≥0.05);对比静脉搭桥组与未搭桥组术后1天、3天、5天、7天及大于1月的门静脉血流峰值,得到术后1天时架桥组门静脉右支峰值流速及术后5天门静脉左支峰值流速显著小于对照组(p0.05),而其余时间两组的门静脉峰值流速无显著性差异(p0.05)。对比术后并发症情况,动脉架桥组与静脉架桥组术后至记录数据当日胆道并发症发生人数与未发生人数比例为2:5和0:4,与未搭桥组(胆道并发症发生人数与未发生人数比例为4:29)无显著性差异(p0.05)。动脉架桥组与静脉架桥组术后至记录数据当日血管并发症发生人数与未发生人数比例为1:6和1:3,与未搭桥组(血管并发症发生人数与未发生人数比例为1:32)无显著性差异(p0.05);对比术后两组患者生存情况,动脉架桥组与静脉架桥组术后至记录数据当日生存情况与未搭桥组无明显差异(p0.05)。结论:在各种原因肝血管无法进行端端吻合的肝移植手术中,血管搭桥可作为一个安全且有效的替代吻合方式,因其并不增加术后胆道并发症及血管并发症的发生,并不影响远期肝功能的恢复,对患者的术后生存率无明显影响。
[Abstract]:Objective: to compare the postoperative complications (mainly vascular complications and biliary complications), liver function recovery and survival rate between patients undergoing hepatic artery or portal bypass grafting and those without bypass grafting. Methods: from November 2011 to September 2016, the first affiliated Hospital of Zhejiang University Medical College was selected from 12 patients (including 7 cases of arterial bridge and 4 cases of venous bridge) who underwent liver transplantation and vascular bridge during operation. The first affiliated Hospital of Zhejiang University School of Medicine received liver transplantation from November 2011 to September 2016, but no vascular graft was performed, and the donor liver was anastomosed with the main portal vein of the recipient. The proportion of recipient anastomosis artery was the same as that in experimental group (33 cases) as control group. The ratio of male and female, age, tumor and blood type match between the artery and vein bypass group and the control group before operation. Preoperative liver function (including alanine aminotransferase (alt), aspartate aminotransferase (AST), total bilirubin (TBN), Albn, prothrombin time (PTT), Child-Pugh score (PELD score in children), cold ischemia time, hot ischemia time, anhepatic phase, etc. There was no significant difference in anastomosis of bile duct (P 0.05). The blood flow of hepatic artery and portal vein were compared between the two groups on 1 day, 3 days, 5 days, 7 days and more than 1 month, respectively, and the blood flow of hepatic artery and portal vein were compared between the two groups. The liver function was more than 1 month after operation and the survival status of the patients was recorded from the first day to the end of the day. Survival data analysis and curve drawing were analyzed by Kaplan-Meier method, chi-square test was used for residual count data, and independent sample t-test was used for measurement data. Results: the liver function of the arteriovenous bypass group was compared with that of the non-bypass group, and the liver function was more than 1 month after operation in the period of 1 day, 2 days, 3 days, 7 days, and more than 1 month, respectively. There was no significant difference between the two groups (P 0.05), and there was no significant difference between the two groups (P < 0.05), and compared the left and right hepatic artery resistance index (RI) and the peak value of blood flow between the artery bypass graft group and the non-bypass graft group on the 1st day, the 3rd day, the 5th day and 7 days after the operation, and the left and right hepatic artery resistance index (RI) were larger than that in the first month. The RI of right and left hepatic artery in the graft group was significantly higher than that in the control group on the 1st day after operation, and the RI of the hepatic artery was significantly lower than that of the control group on the 7th day after operation, but there was no significant difference between the two groups in the peak velocity of hepatic artery. The peak value of portal vein blood flow in the venous bypass group was compared with that in the venous bypass graft group and that in the non-bypass group and the venous bypass graft group respectively on 1 day, 3 days, 5 days, 7 days, and more than 1 month, respectively. The peak velocities of the right portal vein and the left portal vein in the bridging group were significantly lower than those in the control group on the 1st day after operation, but there was no significant difference between the two groups in the other time. Comparing the postoperative complications, There was no significant difference in the number of biliary complications between the arterial bridging group and the venous bridge group from 2:5 to 0: 4 between the two groups (the ratio of the number of biliary complications to none was 4: 29), and there was no significant difference between the two groups (p 0.05). The ratio of the number of vascular complications to non-occurrence was 1:6 and 1: 3 in the arterial bridging group and the vein bridging group, but there was no significant difference between the artery bridging group and the non-bypass graft group (the ratio of the number of vascular complications to the number of non-occurrence was 1: 32). The survival status of the two groups was compared. There was no significant difference between the arterial bridging group and the venous bridging group from the same day to the same day as the non-bypass group (P 0.05). Conclusion: vascular bypass graft can be used as a safe and effective alternative anastomosis in liver transplantation for various reasons, because it does not increase the incidence of postoperative biliary complications and vascular complications. The recovery of long-term liver function was not affected, and the postoperative survival rate was not significantly affected.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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