夜间肝移植手术不增加术后并发症的风险

发布时间：2018-07-06 17:10

本文选题：肝移植 + 夜间手术　；参考：《浙江大学》2016年硕士论文

【摘要】：背景：肝脏移植手术作为终末期肝病的唯一最佳治疗方式,发展至今从操作技术到术后管理都已经有了丰富的经验和长足的进步。但是各种术后并发症也一直伴随着肝移植术的存在。肾脏移植具有较长的冷缺血时间窗口期,提供了将夜间移植推迟到次日的可能性。肝脏移植手术又与之不同,可以不影响预后的冷缺血时间窗口期很短。若是夜间进行肝脏移植手术与白天手术相比并不会增加术后并发症的发生,证明我们现在采取的措施足够安全,更支持我们尽量缩短供肝缺血时间,以实现更好的预后结果。方法：本研究通过回顾性的将在浙江大学医学院附属第一医院进行肝脏移植手术的患者838例,根据其手术时间在白天或是夜间分为两组,通过分析两组间的术后并发症是否存在显著性差异,并通过多因素logistic回归模型找出造成其差异的原因,从而明确夜间进行肝移植手术的风险,并根据单中心的实际经验总结,为肝移植手术安全性提供更好的支持。结果：根据手术进腹时间与关腹时间求得的手术中位时间点定义该次手术时间,9am-9pm为白天手术组,反之是夜间手术组。两组基本信息进行比较年龄、性别、基础疾病、Child-Pugh评分上没有差异(P0.05), MELD评分白天组稍高于夜间组,而缺血时间在夜间组长于白天组。Kaplan-Meier方法分析结果提示夜间手术组与白天手术组的术后总体生存并没有显著性差异。夜间手术组术后全随访期间的胆道并发症、血管并发症、PNF的数量较白天组并没有显著性差异。在移植物失功的发生上夜间组高于白天组(P=0.033),但经过logistic回归模型分析发现手术时间分组被平衡,得到冷缺血时间是影响术后移植物失功的独立风险因素。结论：基于单中心的研究,在夜间进行肝脏移植手术对比在白天手术并不影响长期生存。同时,无论长期还是短期随访结果,夜间手术对胆道并发症、血管并发症、切口并发症等均不增加其发生风险。移植物失功在夜间手术组发生率更高,但是.这是由冷缺血时间导致而与夜间手术本身无关。继续展开多中心的研究可以比较各中心对夜间手术的安排管理,进一步明确改善移植手术预后的管理方法。
[Abstract]:Background: liver transplantation is the only best treatment for end-stage liver disease. However, various postoperative complications have been accompanied by liver transplantation. Kidney transplantation has a long cold ischemic window, providing the possibility of delaying the night transplant to the next day. Unlike liver transplantation, cold ischemic window period is very short without affecting prognosis. If liver transplantation at night does not increase the incidence of postoperative complications compared with daytime surgery, it proves that the measures we take now are safe enough and support us to shorten the time of donor liver ischemia as far as possible to achieve a better prognosis. Methods: a total of 838 patients undergoing liver transplantation in the first affiliated Hospital of Zhejiang University Medical College were divided into two groups according to the time of operation during the day or at night. By analyzing whether there were significant differences in postoperative complications between the two groups, and finding out the causes of the differences by using multivariate logistic regression model, the risk of liver transplantation at night was determined, and the actual experience of single center was summarized. To provide better support for the safety of liver transplantation. Results: according to the median time of operation, 9am-9pm was defined as the daytime operation group and the night operation group as the nocturnal operation group. There was no difference in age, sex and Child-Pugh score between the two groups (P0.05). Meld score in daytime group was slightly higher than that in night group. The results of Kaplan-Meier method showed that there was no significant difference in overall survival between the nocturnal operation group and the daytime operation group. There was no significant difference in the number of vascular complications and PNF between the night operation group and the daytime group. The incidence of graft dysfunction in the night group was higher than that in the daytime group (P0. 033), but the logistic regression model showed that the operative time group was balanced, and the cold ischemia time was an independent risk factor for postoperative graft failure. Conclusion: based on a single-center study, liver transplantation at night does not affect long-term survival compared with daytime surgery. At the same time, the risk of biliary complications, vascular complications and incision complications was not increased by night operation, regardless of the long term or short term follow-up results. The incidence of graft dysfunction was higher in the nocturnal operation group, however. This is due to cold ischemic time and not to the nocturnal operation itself. The multi-center study can be used to compare the management of night operation in different centers and to improve the prognosis of transplantation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.3

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