中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2008年
11期
677-680
,共4页
宋康%樊嘉%周俭%吴志全%黄晓武%孙健%肖永胜%史颖弘%贺轶锋%孙琦蛮%杨国欢%汤钊猷
宋康%樊嘉%週儉%吳誌全%黃曉武%孫健%肖永勝%史穎弘%賀軼鋒%孫琦蠻%楊國歡%湯釗猷
송강%번가%주검%오지전%황효무%손건%초영성%사영홍%하질봉%손기만%양국환%탕쇠유
肝移植%组织和器官获取%器官保存%肝功能试验
肝移植%組織和器官穫取%器官保存%肝功能試驗
간이식%조직화기관획취%기관보존%간공능시험
Liver transplantation%Tissue and organ harvesting%Organ preservation%Liver flletion tests
目的 探讨不同的供肝获取和灌洗方式对移植术后早期肝功能的影响.方法 对442例肝移植的临床资料进行回顾性分析.442例均为尸体供者,供肝切取术中采用腹主动脉和脾静脉插管对供肝进行原位灌洗,灌洗液为4℃UW液或4℃UW液联合高渗枸橼酸盐嘌呤溶液(HC-A液),获取的供肝均保存于UW液中.按照供肝获取方式、灌洗液的种类、灌洗液静脉引流途径及胆道冲洗方法的不同将病例分为5组.肝移植术后1周,测定受者血清总胆红素(TBil)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(γ-GT)及前白蛋白(PA)等肝功能指标,以及活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白(Fb)及国际标准化比值(INR)等凝血功能指标.结果 肝、肾分别切取者的供肝获取手术耗时(17.6±2.5)min,联合切取者为(15.9±2.3)min,二者间的差异有统计学意义(P＜0.05).联合切取者中,灌洗液经颈静脉引流者的γ-GT、AST、PT和INR明显低于经肝下下腔静脉引流者(前一项P＜0.01,后三项P＜0.05),而Fb明显高于经肝下下腔静脉引流者(P＜0.05);采用UW液和HC-A液联合灌洗者,其γ-GT、ALT、AST,DB和TT均明显低于单用UW液灌洗者(前三项P＜0.05,后二项P＜0.01),而Fb明显高于单用UW液灌洗者(P＜0.01).结论 联合切取法有利于缩短器官获取时问;采用UW液和HC-A液联合灌洗及灌洗液经颈静脉引流更有利于术后早期肝功能的恢复.
目的 探討不同的供肝穫取和灌洗方式對移植術後早期肝功能的影響.方法 對442例肝移植的臨床資料進行迴顧性分析.442例均為尸體供者,供肝切取術中採用腹主動脈和脾靜脈插管對供肝進行原位灌洗,灌洗液為4℃UW液或4℃UW液聯閤高滲枸櫞痠鹽嘌呤溶液(HC-A液),穫取的供肝均保存于UW液中.按照供肝穫取方式、灌洗液的種類、灌洗液靜脈引流途徑及膽道遲洗方法的不同將病例分為5組.肝移植術後1週,測定受者血清總膽紅素(TBil)、直接膽紅素(DB)、丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)、堿性燐痠酶(ALP)、γ-穀氨酰轉移酶(γ-GT)及前白蛋白(PA)等肝功能指標,以及活化部分凝血活酶時間(APTT)、凝血酶原時間(PT)、凝血酶時間(TT)、纖維蛋白(Fb)及國際標準化比值(INR)等凝血功能指標.結果 肝、腎分彆切取者的供肝穫取手術耗時(17.6±2.5)min,聯閤切取者為(15.9±2.3)min,二者間的差異有統計學意義(P＜0.05).聯閤切取者中,灌洗液經頸靜脈引流者的γ-GT、AST、PT和INR明顯低于經肝下下腔靜脈引流者(前一項P＜0.01,後三項P＜0.05),而Fb明顯高于經肝下下腔靜脈引流者(P＜0.05);採用UW液和HC-A液聯閤灌洗者,其γ-GT、ALT、AST,DB和TT均明顯低于單用UW液灌洗者(前三項P＜0.05,後二項P＜0.01),而Fb明顯高于單用UW液灌洗者(P＜0.01).結論 聯閤切取法有利于縮短器官穫取時問;採用UW液和HC-A液聯閤灌洗及灌洗液經頸靜脈引流更有利于術後早期肝功能的恢複.
목적 탐토불동적공간획취화관세방식대이식술후조기간공능적영향.방법 대442례간이식적림상자료진행회고성분석.442례균위시체공자,공간절취술중채용복주동맥화비정맥삽관대공간진행원위관세,관세액위4℃UW액혹4℃UW액연합고삼구연산염표령용액(HC-A액),획취적공간균보존우UW액중.안조공간획취방식、관세액적충류、관세액정맥인류도경급담도충세방법적불동장병례분위5조.간이식술후1주,측정수자혈청총담홍소(TBil)、직접담홍소(DB)、병안산전안매(ALT)、천동안산전안매(AST)、감성린산매(ALP)、γ-곡안선전이매(γ-GT)급전백단백(PA)등간공능지표,이급활화부분응혈활매시간(APTT)、응혈매원시간(PT)、응혈매시간(TT)、섬유단백(Fb)급국제표준화비치(INR)등응혈공능지표.결과 간、신분별절취자적공간획취수술모시(17.6±2.5)min,연합절취자위(15.9±2.3)min,이자간적차이유통계학의의(P＜0.05).연합절취자중,관세액경경정맥인류자적γ-GT、AST、PT화INR명현저우경간하하강정맥인류자(전일항P＜0.01,후삼항P＜0.05),이Fb명현고우경간하하강정맥인류자(P＜0.05);채용UW액화HC-A액연합관세자,기γ-GT、ALT、AST,DB화TT균명현저우단용UW액관세자(전삼항P＜0.05,후이항P＜0.01),이Fb명현고우단용UW액관세자(P＜0.01).결론 연합절취법유리우축단기관획취시문;채용UW액화HC-A액연합관세급관세액경경정맥인류경유리우술후조기간공능적회복.
Objective To compare the effects of different methods of liver graft harvesting and perfusion on early liver function after transplantation.Methods The clinical data of 442 cases of cadavefic liver transplantation was retrospectively analyzed.The techniques for graft harvesting included in situ perfusion through abdominal aorta and splenic vein.UW solution and hypertonic citrate adeniBe solution(HCA)at 4℃ were used for organ perfusion and preservation. All cases were divided into 5 groups according to different methods of harvesting,perfusion,drainage through vena cava and irrigation of biliary tract.The liver function and blood coagulation were observed by groups one week after liver transplantation.Results There were significant differences betwin the time of separate and combined harvesting(P＜0.05).There were no significant differences in all indexes between the above two methods,as well as perfusion of UW solution and combined HCA solution(P>0.05).There were significant differences in aspartate aminotransferase(AST),prothrombin time (PT),international normalized ratio (INR) and fibrinogen (Fb) between groups by drainage through jugular vein and inferior vena cava(P＜0.05).There was significant difference in γ-glutamyl transpeptidase(γ-GT)between groups by irrigation through gallbladder and combined choledochus(P＜0.01).There were significant differences in γ-GT,alanine aminotransferase (ALT),AST,direct bilirubin(DB),Fb and thrombin time(TT)between groups by the improved method of combined harvesting and the original method(P＜0.05).Conclusion It iS suggested that the modified techniques of combined rapid harvesting and perfusion are simple,efficient and safe to improve the utilization and the quality of cadaveric organs,and the recovery of liver function after transplantation.
