CAJ | 학술논문

目的分析胆道闭锁(BA)儿童肝脏移植的临床疗效及预后.方法对2006年9月至2013年10月期间的130例BA患儿资料进行回顾性分析.分析肝移植术前有无Kasai手术史、移植手术方式、术前及术中参数与预后的关系以及各种并发症的发生情况.结果 130例患儿中术前已行Kasai手术的患儿80例,中位年龄为12.8个月(5.9～136.4个月),术前行腹部探查的患儿23例,中位年龄为7.4个月(5.8～43.0个月),无腹部手术史的患儿27例,中位年龄9.0个月(6.0～18.0个月),已行Kasai手术的患儿比其他患儿接受移植时的年龄明显延长,差异有统计学意义(P＜0.01).130例小儿肝移植中,活体肝移植94例,劈离式肝移植19例,DCD全肝移植17例;共有11例患儿死亡;受者中位年龄10.0个月(5.8～136.4个月);中位体重8.0kg(4.5～37.0 kg);中位随访时间为10.1个月(3.6～149.3个月);全部患儿1年、2年和3年受者累计生存率分别为92.1.0％、90.0％和90.0％,活体肝移植受者1年、2年和3年受者累计生存率分别为94.4％、94.4％和94.4％,劈离式肝移植受者1年、2年和3年受者累计生存率分别为84.2％、77.2％和77.2％;单因素Kaplan-Meier分析结果显示性别、移植物类型、供肝受体质量比(GRWR)、冷缺血时间、术后再次气管插以及受体是否有术后早期并发症因素与术后生存率相关;多因素Cox结果表明GRWR、术后再次气管插管、受体是否有术后早期并发症因素是预后的影响因素.结论肝脏移植做为治疗胆道闭锁等儿童终末期肝病的有效手段已经取得较好的疗效,活体肝移植与尸体供肝肝移植相比,受者可获得更为满意的长期生存.
목적 분석담도폐쇄(BA)인동간장이식적림상료효급예후.방법 대2006년9월지2013년10월기간적130례BA환인자료진행회고성분석.분석간이식술전유무Kasai수술사、이식수술방식、술전급술중삼수여예후적관계이급각충병발증적발생정황.결과 130례환인중술전이행Kasai수술적환인80례,중위년령위12.8개월(5.9～136.4개월),술전행복부탐사적환인23례,중위년령위7.4개월(5.8～43.0개월),무복부수술사적환인27례,중위년령9.0개월(6.0～18.0개월),이행Kasai수술적환인비기타환인접수이식시적년령명현연장,차이유통계학의의(P＜0.01).130례소인간이식중,활체간이식94례,벽리식간이식19례,DCD전간이식17례;공유11례환인사망;수자중위년령10.0개월(5.8～136.4개월);중위체중8.0kg(4.5～37.0 kg);중위수방시간위10.1개월(3.6～149.3개월);전부환인1년、2년화3년수자루계생존솔분별위92.1.0％、90.0％화90.0％,활체간이식수자1년、2년화3년수자루계생존솔분별위94.4％、94.4％화94.4％,벽리식간이식수자1년、2년화3년수자루계생존솔분별위84.2％、77.2％화77.2％;단인소Kaplan-Meier분석결과현시성별、이식물류형、공간수체질량비(GRWR)、랭결혈시간、술후재차기관삽이급수체시부유술후조기병발증인소여술후생존솔상관;다인소Cox결과표명GRWR、술후재차기관삽관、수체시부유술후조기병발증인소시예후적영향인소.결론 간장이식주위치료담도폐쇄등인동종말기간병적유효수단이경취득교호적료효,활체간이식여시체공간간이식상비,수자가획득경위만의적장기생존.
Objective To analyze the clinical efficacy and prognosis of liver transplantation (LT) in children with biliary atresia (BA).Methods Retrospective analyses were performed for 130 BA patients undergoing LT from September 2006 to October 2013.The relationship between history of Kasai operation,surgical procedures,pre-& intra-operative parameters,prognosis and occurrence of various complications was analyzed.Results Among them,80 cases had a history of Kasai operation.Their median age was 12.8 (5.9-136.4) months.And 23 cases had a history of abdominal exploration and a median age of 7.4 (5.8-43.0) months.For 27 cases without a history of abdominal surgery,their median age was 9.0(6.0-18.0) months.The age at transplantation was significantly longer in children with a history of Kasai operation than other children (P＜ 0.01).The transplantation procedures included living donor liver (n =94),split liver (n =19) and 17 donation after cardiac death (DCD) whole liver (n =17).Eleven patients died during follow-up.The median recipient age was 10.0 (5.8-136.4) months,median weight 8.0 (4.5-37.0) kg and median follow-up time 10.1 (0.2-87.4) months.The overall 1,2 & 3-year cumulative survival rates were 92.1％,90.0％ and 90.0％; 1,2 & 3-year cumulative survival rates of lving donor liver transplantation (LDLT) were 94.4％,94.4％ and 94.4％ and 1,2 & 3-year cumulative survival rate of split liver transplantation (SPLT) were 84.2％,77.2％ and 77.2％ respectively.Univariate analysis showed that gender,type of graft,graft/recipient's body weight ratio (GRWR),cold ischemia time,postoperative re-intubation and early post-LT complications were associated with survival rate.Multivariable Cox results showed that GRWR,re-intubation and early post-LT complications were the influencing factors of prognosis.Conclusions As an effective treatment,liver transplantation in BA children has achieved satisfactory outcomes.Compared with cadaveric liver transplantation,LDLT may obtain more satisfactory long-term survival.