CAJ | 학술논문

目的探讨不同移植肝类型的活体肝移植供体术后早期肝功能的变化规律和并发症发生率.方法对四川大学华西医院2002年1月至2009年5月154例活体肝移植供体的资料进行前瞻性的收集和登记,依据移植肝类型分为右叶肝供体组141例(R组)和左叶肝供体组13例(L组),对其术后肝功能指标和并发症进行比较分析.结果 R组实际切取的供肝重量大于L组(t=11.418,P＜0.05),R组残余肝重量小于L组(t=-5.040,P＜0.05)、残余肝重量/标准肝重量(%)小于L组(t=-10.841,P＜0.05).除R组TB峰值出现在术后第3天外,L组的TB和两组中的ALT、AST、INR的峰值均出现在术后第1天,此后这些指标均向正常参考值方向下降.术后第1、3、7天R组的TB高于L组(分别t1=5.285,t3=3.747,t7=2.729,均P＜0.05).术后第1、3、7天R组的INR高于L组(分别t1=5.260,t3=5.035,t7=2.267,均P＜0.05).本组活体肝移植无供体死亡,供体总的并发症发生为53/154(34.42%),R组52/141(36.88%),L组1/13(7.69%),2组比较差异无统计学意义(x2=3.292,P＞0.05).结论右叶肝供体组(大体积供肝组)与左叶肝供体组相比,供体术后早期肝功能损害更大;供体总体安全性较好,但仍面临着一定的并发症风险.
목적 탐토불동이식간류형적활체간이식공체술후조기간공능적변화규률화병발증발생솔.방법 대사천대학화서의원2002년1월지2009년5월154례활체간이식공체적자료진행전첨성적수집화등기,의거이식간류형분위우협간공체조141례(R조)화좌협간공체조13례(L조),대기술후간공능지표화병발증진행비교분석.결과 R조실제절취적공간중량대우L조(t=11.418,P＜0.05),R조잔여간중량소우L조(t=-5.040,P＜0.05)、잔여간중량/표준간중량(%)소우L조(t=-10.841,P＜0.05).제R조TB봉치출현재술후제3천외,L조적TB화량조중적ALT、AST、INR적봉치균출현재술후제1천,차후저사지표균향정상삼고치방향하강.술후제1、3、7천R조적TB고우L조(분별t1=5.285,t3=3.747,t7=2.729,균P＜0.05).술후제1、3、7천R조적INR고우L조(분별t1=5.260,t3=5.035,t7=2.267,균P＜0.05).본조활체간이식무공체사망,공체총적병발증발생위53/154(34.42%),R조52/141(36.88%),L조1/13(7.69%),2조비교차이무통계학의의(x2=3.292,P＞0.05).결론 우협간공체조(대체적공간조)여좌협간공체조상비,공체술후조기간공능손해경대;공체총체안전성교호,단잉면림착일정적병발증풍험.
Objective To investigate the liver function injury and the rate of complications in living liver transplantation donors in different graft type transplantation.Methods Postoperative data of 154 living liver donors satisfying our inclusion criteria were prospectively collected and registered from Jan 2002 to May 2009 in our hospital.We divided the donors into two groups (right-lobe graft, R group and left-lobe graft, L group), and made comparison on the liver function and complications.Results Remnant liver weight in R group were smaller than those in L group (t = 11.418, P ＜ 0.05).the ratio of remnant liver weight to standard liver weight in R group were smaller than those in L group (t = - 5.040, P ＜ 0.05 ) .Peaks of ALT, AST and INR in both groups appeared on the first day after operation, while the peak of TB in R group appeared on the third day after operation.All the index values returned to a normal baseline after reaching its peak.Mean values of TB in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.285, t3 = 3.747, t7 = 2.729, all P ＜ 0.05).Mean values of INR in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.260, t3 = 5.035, t7 = 2.267, all P ＜ 0.05).The level of TB in both groups returned to normal range on the 7th postoperative day, while the level of ALT and AST remained twice the upper limits of the normal.There were no deaths; Complications occurred in 53 of 154 donors (34.42% ) , 52/141 (36.88% ) in R group and 1/13 (7.69% ) in L group (x2 = 3.292, P ＞ 0.05).Conclusions Ramnant liver function of R group during early postoperative period was poorer than that of the L group.Donors were safe, though suffering from comparatively high complication rate.