中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2012年
6期
411-415
,共5页
钱道海%刘钦%汪小辉%潘春鹏%沈柏用%鲍国清%王以巧%彭承宏%祝哲诚%邓侠兴%詹茜%李宏为
錢道海%劉欽%汪小輝%潘春鵬%瀋柏用%鮑國清%王以巧%彭承宏%祝哲誠%鄧俠興%詹茜%李宏為
전도해%류흠%왕소휘%반춘붕%침백용%포국청%왕이교%팽승굉%축철성%산협흥%첨천%리굉위
活体肝移植%小体积综合征%肝动脉缓冲效应%胆道并发症
活體肝移植%小體積綜閤徵%肝動脈緩遲效應%膽道併髮癥
활체간이식%소체적종합정%간동맥완충효응%담도병발증
Living donor liver transplantation%Small-for-size syndrome (SFSS)%Hepatic arterial buffer response (HABR)%Early biliary complications
目的 研究活体肝移植术后肝动脉缓冲效应(hepatic arterial buffer response,HABR)与肝功能恢复、早期胆道并发症及小体积综合征( small-for-size syndrome,SFSS)的关系.方法 通过监测34例活体肝移植受者术前及术后肝动脉缓冲效应相关参数(肝动脉及门静脉流量等),结合肝功能、超声、CT及内镜逆行胆胰管造影(ERCP),分析其与早期胆道并发症及小体积综合征的关系.结果 34例患者中11例术后早期(被动)肝动脉缓冲效应一直存在(组1),23例消失(组2).组1患者术后丙氨酸转氨酶(ALT)(11.6±9.0)d、天冬氨酸转氨酶(AST) (10.6±8.8)d、总胆红素(TBil)(平均29 d)的恢复快于组2,但差异无统计学意义(P＞0.05).组1患者在早期胆道并发症和小体积综合征(SFSS)的总发生率(分别为9％和37.0％)上显著低于组2(分别为39.0％和65.0％),差异有统计学意义(P＜0.05).结论 活体肝移植术后早期多数患者(被动)肝动脉缓冲效应消失,这很可能是导致早期胆道并发症及小体积综合征的原因;术后早期监测肝动脉缓冲效应能预测并防治早期胆道并发症及小体积综合征,避免移植手术失败.
目的 研究活體肝移植術後肝動脈緩遲效應(hepatic arterial buffer response,HABR)與肝功能恢複、早期膽道併髮癥及小體積綜閤徵( small-for-size syndrome,SFSS)的關繫.方法 通過鑑測34例活體肝移植受者術前及術後肝動脈緩遲效應相關參數(肝動脈及門靜脈流量等),結閤肝功能、超聲、CT及內鏡逆行膽胰管造影(ERCP),分析其與早期膽道併髮癥及小體積綜閤徵的關繫.結果 34例患者中11例術後早期(被動)肝動脈緩遲效應一直存在(組1),23例消失(組2).組1患者術後丙氨痠轉氨酶(ALT)(11.6±9.0)d、天鼕氨痠轉氨酶(AST) (10.6±8.8)d、總膽紅素(TBil)(平均29 d)的恢複快于組2,但差異無統計學意義(P＞0.05).組1患者在早期膽道併髮癥和小體積綜閤徵(SFSS)的總髮生率(分彆為9％和37.0％)上顯著低于組2(分彆為39.0％和65.0％),差異有統計學意義(P＜0.05).結論 活體肝移植術後早期多數患者(被動)肝動脈緩遲效應消失,這很可能是導緻早期膽道併髮癥及小體積綜閤徵的原因;術後早期鑑測肝動脈緩遲效應能預測併防治早期膽道併髮癥及小體積綜閤徵,避免移植手術失敗.
목적 연구활체간이식술후간동맥완충효응(hepatic arterial buffer response,HABR)여간공능회복、조기담도병발증급소체적종합정( small-for-size syndrome,SFSS)적관계.방법 통과감측34례활체간이식수자술전급술후간동맥완충효응상관삼수(간동맥급문정맥류량등),결합간공능、초성、CT급내경역행담이관조영(ERCP),분석기여조기담도병발증급소체적종합정적관계.결과 34례환자중11례술후조기(피동)간동맥완충효응일직존재(조1),23례소실(조2).조1환자술후병안산전안매(ALT)(11.6±9.0)d、천동안산전안매(AST) (10.6±8.8)d、총담홍소(TBil)(평균29 d)적회복쾌우조2,단차이무통계학의의(P＞0.05).조1환자재조기담도병발증화소체적종합정(SFSS)적총발생솔(분별위9％화37.0％)상현저저우조2(분별위39.0％화65.0％),차이유통계학의의(P＜0.05).결론 활체간이식술후조기다수환자(피동)간동맥완충효응소실,저흔가능시도치조기담도병발증급소체적종합정적원인;술후조기감측간동맥완충효응능예측병방치조기담도병발증급소체적종합정,피면이식수술실패.
Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.
