中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2008年
7期
500-502
,共3页
朱晓峰%廖海华%何晓顺%马毅%王东平%王国栋%胡安兵%鞠卫强%巫林伟%邰强
硃曉峰%廖海華%何曉順%馬毅%王東平%王國棟%鬍安兵%鞠衛彊%巫林偉%邰彊
주효봉%료해화%하효순%마의%왕동평%왕국동%호안병%국위강%무림위%태강
肝移植%供体%脂肪肝
肝移植%供體%脂肪肝
간이식%공체%지방간
Liver transplantation%Donor%Steatotic grafts
目的 探讨脂肪供肝对肝移植术后早期肝功能和半年预后的影响.方法 中山大学附属第一医院近3年使用UW液体灌注的首次肝移植患者76例,其中脂肪供肝35例,按肝脂肪变性程度分3组(＜20%组,20%～40%组,≥40%组),无脂肪变性供肝41例为对照组,分别比较各组术后当天、1、2、3、7 d的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平、总胆红素(TB)、凝血酶原时间(PT),ICU时间、迟发性无功能(DNF)发生率和3、6个月患者生存率等各项指标.并对35例脂肪变性供肝程度和术后肝功能关系进行相关性分析. 结果肝脂肪变性≥140%组的术后ALT、AST、TB、PT均高于脂肪变性20%～40%组,脂肪变性20%～40%组术后的AST,ALT,TB均高与脂肪变性＜20%,供肝脂肪变性＜20%组各项指标与对照组差异不显著,各组术后DNF发生率和3、6个月存活率均无统计学差异.脂肪变性程度和术后肝功能的相关性分析显示,随脂肪变性程度增大,肝功能损害逐步加重,相关性有显著意义.结论 供肝脂肪变性＜20%对肝移植术后肝功能影响较小,作为供肝较为安全;供肝脂肪变性≥20%对肝移植术后肝功能损害明显加重,增加术后肝功能衰竭的风险,应慎重使用;对脂肪变性≥40%供肝应更慎重或避免使用.
目的 探討脂肪供肝對肝移植術後早期肝功能和半年預後的影響.方法 中山大學附屬第一醫院近3年使用UW液體灌註的首次肝移植患者76例,其中脂肪供肝35例,按肝脂肪變性程度分3組(＜20%組,20%～40%組,≥40%組),無脂肪變性供肝41例為對照組,分彆比較各組術後噹天、1、2、3、7 d的丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)水平、總膽紅素(TB)、凝血酶原時間(PT),ICU時間、遲髮性無功能(DNF)髮生率和3、6箇月患者生存率等各項指標.併對35例脂肪變性供肝程度和術後肝功能關繫進行相關性分析. 結果肝脂肪變性≥140%組的術後ALT、AST、TB、PT均高于脂肪變性20%～40%組,脂肪變性20%～40%組術後的AST,ALT,TB均高與脂肪變性＜20%,供肝脂肪變性＜20%組各項指標與對照組差異不顯著,各組術後DNF髮生率和3、6箇月存活率均無統計學差異.脂肪變性程度和術後肝功能的相關性分析顯示,隨脂肪變性程度增大,肝功能損害逐步加重,相關性有顯著意義.結論 供肝脂肪變性＜20%對肝移植術後肝功能影響較小,作為供肝較為安全;供肝脂肪變性≥20%對肝移植術後肝功能損害明顯加重,增加術後肝功能衰竭的風險,應慎重使用;對脂肪變性≥40%供肝應更慎重或避免使用.
목적 탐토지방공간대간이식술후조기간공능화반년예후적영향.방법 중산대학부속제일의원근3년사용UW액체관주적수차간이식환자76례,기중지방공간35례,안간지방변성정도분3조(＜20%조,20%～40%조,≥40%조),무지방변성공간41례위대조조,분별비교각조술후당천、1、2、3、7 d적병안산전안매(ALT)、천동안산전안매(AST)수평、총담홍소(TB)、응혈매원시간(PT),ICU시간、지발성무공능(DNF)발생솔화3、6개월환자생존솔등각항지표.병대35례지방변성공간정도화술후간공능관계진행상관성분석. 결과간지방변성≥140%조적술후ALT、AST、TB、PT균고우지방변성20%～40%조,지방변성20%～40%조술후적AST,ALT,TB균고여지방변성＜20%,공간지방변성＜20%조각항지표여대조조차이불현저,각조술후DNF발생솔화3、6개월존활솔균무통계학차이.지방변성정도화술후간공능적상관성분석현시,수지방변성정도증대,간공능손해축보가중,상관성유현저의의.결론 공간지방변성＜20%대간이식술후간공능영향교소,작위공간교위안전;공간지방변성≥20%대간이식술후간공능손해명현가중,증가술후간공능쇠갈적풍험,응신중사용;대지방변성≥40%공간응경신중혹피면사용.
Objective To evaluate the impact of steatotic hepatic grafts on postoperative early liver function and prognosis.Methods Clinical data of 35 cases receiving steatotic liver grafts in our hospital were retrospectively analyzed.The donor liver grafts were divided into 3 groups based on the degree of fatty infiltration(＜20%group,20%～40%group,≥40%group).Results were compared with that from control normal grafts(41 cases).Liver function parameters including AST,ALT,TB,PT on the day of surgery and 1,2,3,7 days later were monitored among the 4 groups,as well as the incidence of delayed nonfunction (DNF),and 3 and 6 months patient survival rate.Analysis of the correlation between degree of donor steatosis and liver function after operation was carried out.Resuits There was significant difference in postoperative ALT、AST、TB、PT level between≥40%group and 20%～40%group,and between 20%～40%and group＜20%group.There was no significant difference among the groups in DNF occurrence rate and 3 month.6 month patient survival rate.Correlation analysis suggested that the degree of donor steatosis was positively correlated with the damage of liver function.Conclusions Grafts with≤20% steatosis was safe,whereas≥20% especially ≥40% steatosis carries a high risk of posttransplant liver dysfunction even delayed nonfunction.
