中华移植杂志（电子版）
中華移植雜誌（電子版）
중화이식잡지（전자판）
Chinese Journal of Transplantation(Electronic Version)
2008年
1期
10-14
,共5页
段键%曾仲%张敏%徐王刚%喻智勇
段鍵%曾仲%張敏%徐王剛%喻智勇
단건%증중%장민%서왕강%유지용
肝移植%缺血再灌注%高胆红素血症
肝移植%缺血再灌註%高膽紅素血癥
간이식%결혈재관주%고담홍소혈증
Liver transplantation%Ischemic- reperfusion injury,Hyperbilirubinemia
目的 分析缺血再灌注损伤对同种异体原位肝移植后受者胆红素变化的影响. 方法 30例入选患者监测术前及术后15天内肝功能数据进行统计学分析,同时在手术中获取冷缺血时及再灌注后供体肝脏组织进行光镜及电镜检查.结果 肝移植术后存在一过性高胆红素血症(术后11天内),血总胆红素术后第1天(78.84±34.59)mmol/L,较术前(21.60±8.03)mmol/L明显升高(P<0.05),碱性磷酸酶术前中位数40.46IU/L,术后第1天中位数19.27 IU/L,术后1天较术前降低(P<0.05).胆汁酸术前中位数32.93ummol/L,术后第1天中位数20.85 ummol/L,术后1天较术前降低(P<0.05).γ-谷氨酰转肽酶术前中位数28.81 IU/L,术后第1天中位数29.17IU/L,术后1天γ-谷氨酰转肽酶较术前升高没有显著差异(P>0.05).术前直接胆红素/总胆红素比值为(39.85%±12.51%),术后1天比值为(54.25%±7.6%),术后较术前升高(P<0.05).同时,光学显微镜及电子显微镜形态学检查没有发现肝细胞外胆汁瘀积,胆红素主要淤积于肝细胞水平.结论 缺血再灌注损伤导致患者肝移植术后早期出现以直接胆红素升高为主的一过性高胆红素血症,并在术后11天左右降至术前水平.胆汁瘀积主要发生于肝细胞水平.
目的 分析缺血再灌註損傷對同種異體原位肝移植後受者膽紅素變化的影響. 方法 30例入選患者鑑測術前及術後15天內肝功能數據進行統計學分析,同時在手術中穫取冷缺血時及再灌註後供體肝髒組織進行光鏡及電鏡檢查.結果 肝移植術後存在一過性高膽紅素血癥(術後11天內),血總膽紅素術後第1天(78.84±34.59)mmol/L,較術前(21.60±8.03)mmol/L明顯升高(P<0.05),堿性燐痠酶術前中位數40.46IU/L,術後第1天中位數19.27 IU/L,術後1天較術前降低(P<0.05).膽汁痠術前中位數32.93ummol/L,術後第1天中位數20.85 ummol/L,術後1天較術前降低(P<0.05).γ-穀氨酰轉肽酶術前中位數28.81 IU/L,術後第1天中位數29.17IU/L,術後1天γ-穀氨酰轉肽酶較術前升高沒有顯著差異(P>0.05).術前直接膽紅素/總膽紅素比值為(39.85%±12.51%),術後1天比值為(54.25%±7.6%),術後較術前升高(P<0.05).同時,光學顯微鏡及電子顯微鏡形態學檢查沒有髮現肝細胞外膽汁瘀積,膽紅素主要淤積于肝細胞水平.結論 缺血再灌註損傷導緻患者肝移植術後早期齣現以直接膽紅素升高為主的一過性高膽紅素血癥,併在術後11天左右降至術前水平.膽汁瘀積主要髮生于肝細胞水平.
목적 분석결혈재관주손상대동충이체원위간이식후수자담홍소변화적영향. 방법 30례입선환자감측술전급술후15천내간공능수거진행통계학분석,동시재수술중획취랭결혈시급재관주후공체간장조직진행광경급전경검사.결과 간이식술후존재일과성고담홍소혈증(술후11천내),혈총담홍소술후제1천(78.84±34.59)mmol/L,교술전(21.60±8.03)mmol/L명현승고(P<0.05),감성린산매술전중위수40.46IU/L,술후제1천중위수19.27 IU/L,술후1천교술전강저(P<0.05).담즙산술전중위수32.93ummol/L,술후제1천중위수20.85 ummol/L,술후1천교술전강저(P<0.05).γ-곡안선전태매술전중위수28.81 IU/L,술후제1천중위수29.17IU/L,술후1천γ-곡안선전태매교술전승고몰유현저차이(P>0.05).술전직접담홍소/총담홍소비치위(39.85%±12.51%),술후1천비치위(54.25%±7.6%),술후교술전승고(P<0.05).동시,광학현미경급전자현미경형태학검사몰유발현간세포외담즙어적,담홍소주요어적우간세포수평.결론 결혈재관주손상도치환자간이식술후조기출현이직접담홍소승고위주적일과성고담홍소혈증,병재술후11천좌우강지술전수평.담즙어적주요발생우간세포수평.
Objective To analyze the influence of ischemic- reperfusion injury to the bilirubin's metabolism of paitients in the early stage after orthotopic liver transplantation. Method 30 patients are included in the test. Datas of liver function are monitored before and after transplantation. Statistics analysis is done to evaluate the tendency of these datas. Biopsy of donors' livers are done before and after reperfusion. Results The concentration of bilirubin after liver transplantation is increased(p<0.05), while the concentration of glutamyltranspeptidase is not increased, even the concentration of alkaline phosphatase and bile acid is degrade. The concentration of direct bilirubin is increased predominantly(p<0.05). Meanwhile , there is no jaundice detected in biliary tract by light microscope and electron microscope test. Conclusions Hyperbilirubinemia is induced by ischemic- reperfusion injury within 11 days after liver transplantation. Cholestasis developes within cellular level, which manifests hepatocyte's transport function of direct bilirubin is damaged during ischemia-reperfusion.
