儿童死亡后器官捐献及供肝应用的临床研究

发布时间：2019-02-09 13:31

【摘要】：目的:开展儿童死亡后器官捐献工作,增加儿童供肝的器官来源,缓解器官短缺,同时研究儿童死亡后捐献供肝的临床应用。方法:1.儿童死亡后器官捐献工作回顾性研究自2014年3月至2015年3月期间,北京友谊医院完成的儿童死亡后器官捐献,严格按照《中国人体器官捐献工作指南》开展器官捐献工作,详细记录潜在捐献者的各项基本资料、供者临床检查资料、重要脏器功能评估与维护、器官获取过程及临床应用。2.儿童死亡后捐献供肝-儿童肝脏移植临床研究分析北京友谊医院自2013年6月至2015年3月期间完成的使用儿童死亡后器官捐献供肝的儿童肝移植患者,详细记录受者的年龄、性别、诊断、移植指征、术中基本数据和供者的基本资料。记录肝移植术后肝功能恢复情况,统计血管并发症、胆道并发症等,术后生存率及死亡原因分析。3.儿童死亡后捐献供者在成人肝移植中的应用分析北京友谊医院自2013年6月至2015年3月实施的接受儿童死亡后捐献供肝的成人肝移植患者(大于18岁);包括本院实施捐献案例和通过国家器官共享网络分配来的器官。与儿童肝移植一样,收集供受者资料,主要研究受者选择,手术方式选择,小肝综合征的防治,术后血管并发症的防治等方面进行临床研究。结果:1.自2014年3月至2015年3月,北京友谊医院实施捐献案例13例,发现潜在捐献者46人,捐献成功率为28.3%。其中儿童成功捐献10例,潜在捐献者29例,捐献成功率为34.5%。成功捐献出肝脏10例,肾脏22例,心脏1例;其中最小的捐献者,为出生后7天,体重最小的为3Kg。除了2例肝脏,2例肾脏临床弃用外其余都临床应用;8例肝脏临床使用,术后受者恢复顺利,2例肾脏受者术后出现移植肾功能延迟恢复,1例肾移植受者术后早期死亡。2.2014年3月至2015年3月期间开展儿童死亡后捐献器官供肝给儿童患者共51例,患儿及移植物6个月、1年存活率均为87.1%。术后无原发性移植物失功发生,1例患者出现移植肝功能延迟恢复,发生率为2.0%;术后早期7例患儿出现肝动脉血栓,发生率为17.6%,2例门静脉血栓,发生率为3.9%,胆道并发症5例,发生率为9.8%;死亡患者7例,1例术后早期死于呼吸循环功能衰竭,2例死于移植物功能衰竭,1例术后2月死于麻疹病毒感染,1例术后半年死于副伤寒感染,2例术后在家放弃治疗死亡。3.自2013年6月至2015年3月在北京友谊医院实施的成人肝移植患者,其中16例接受了儿童死亡后捐献的供肝,15例手术采用经典非转流术式,1例手术采用背驮式肝移植,9例患者术中行门静脉血流调整。术后1例出现小肝综合征,2例出现肝动脉血栓形成。16例患者中死亡1例,其余均健康存活。结论:肝移植是治疗儿童终末期肝病和代谢性疾病的有效方法,儿童死亡后捐献工作比成人死亡后捐献工作相对容易,供者脏器功能评估和维护很重要,会直接影响受者的预后。儿童死亡后捐献供肝在儿童肝移植应用中,其肝动脉血栓发生几率明显高于活体肝移植患儿,儿童肝移植术后机会感染比较多。儿童供肝在成人肝移植中的应用中,小肝综合征和动脉血栓风险较高,需谨慎选择供体及积极调整门静脉血流,总体效果满意。
[Abstract]:Objective: To study the organ donation after the death of children, to increase the source of the organs of the children for the liver, to relieve the shortage of the organs, and to study the clinical application of the donor to the liver after the death of the children. Method: 1. The retrospective study on organ donation after the death of children from March 2014 to March 2015, the post-death organ donation completed by the Beijing Friendship Hospital, and the organ donation work in strict accordance with the Guidelines on the Contribution of the Human Organs of China. The basic data of the potential donors, the data of the donor's clinical examination, the evaluation and maintenance of important organ function, the process of organ acquisition and the clinical application were recorded in detail. After the death of the child, a clinical study of the liver-child liver transplantation was donated for the analysis of the clinical study of the liver transplantation in Beijing Friendship Hospital from June 2013 to March 2015 for children with liver transplantation for liver transplantation, and the age, sex, diagnosis and transplantation of the recipient were recorded in detail. Basic data of the intraoperative basic data and the donor. The recovery of liver function after liver transplantation was recorded, and the postoperative survival rate and the cause of death were analyzed. The application of donor in adult liver transplantation after the death of children was analyzed by the application of the donor after the death of the children from June 2013 to March 2015, and the recipients of the adult liver transplantation (more than 18 years of age) donated for the liver after the death of the child. It includes the case of the implementation of the donation by the Court and the organ allocated through the national organ sharing network. As with children's liver transplantation, the data of the recipient is collected, and the selection of the recipient, the selection of the operation method, the prevention and treatment of the small liver syndrome, the prevention and treatment of postoperative vascular complications and the like are mainly studied. Results: 1. From March 2014 to March 2015, 13 cases were implemented in Beijing Friendship Hospital, and 46 of the potential donors were found. The success rate of the donation was 28. 3%. Of these, 10 cases were successfully donated, 29 were potential donors, and the success rate was 34.5%. 10 cases of the liver, 22 cases of the kidney and 1 case of the heart were successfully donated. The minimum donor was 3Kg with a minimum body weight of 7 days after the birth. In addition to 2 cases of the liver, 2 cases of renal clinical rejection were used in the rest of the clinical application, and 8 cases of the liver were used clinically, The results showed that the recovery of renal function after operation and the recovery of delayed renal function after operation in 2 cases of renal transplant recipients, 1 case of early death after the operation of renal transplant recipients, and 51 cases of the donor organ donor organ for the children after the death of the child from March 2014 to March 2015, The 1-year survival rate of the children and the graft was 87.1%. After operation, there was no primary graft loss, and 1 case had a delayed recovery of liver function, with a rate of 2.0%. In the early 7 cases, the incidence of hepatic artery thrombosis was 17. 6%, the incidence of portal vein thrombosis was 30.9%, and the incidence of biliary complications was 9. 8%. In 7 cases of death, 1 case died in the function of respiratory cycle, 2 cases died of graft function failure, 1 case died in measles virus infection in 2 months, one case died in paratyphoid infection in half a year, and 2 cases died at home after operation. 3. From June 2013 to March 2015, 16 cases of adult liver transplantation were performed in the Beijing Friendship Hospital, 16 of which received the donor's liver after the death of the child. The 15 cases received the classic non-bypass procedure. One case underwent a piggyback liver transplantation, and the portal vein blood flow was adjusted in 9 patients. There were 1 case of small liver syndrome and 2 cases of hepatic artery thrombosis. One case died in 16 cases, and the rest were healthy and alive. Conclusion: Liver transplantation is an effective method for the treatment of end-stage liver disease and metabolic diseases of children. The post-death of children is relatively easy to donate after the death of the adult. The evaluation and maintenance of the organ function of the donor are very important, and the prognosis of the recipient is directly affected. The incidence of hepatic artery thrombosis of children after death of children is higher than that of in-vivo liver transplantation. In the application of children's liver in adult liver transplantation, the risk of small liver syndrome and arterial thrombosis is high, the donor should be carefully selected and the portal blood flow can be adjusted positively, and the overall effect is satisfactory.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R726.5

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