CAJ | 학술논문

目的探讨进一步降低儿童心脏死亡器官捐献(DCD)供肝肝移植术后肝动脉并发症的措施.方法回顾性分析2011年7月至2014年4月我院完成的17例儿童DCD供肝肝移植临床资料.本组供肝符合DCD器官捐献标准,均由中国人体器官分配与共享系统(COTRS)分配.本组17例受者中胆道闭锁伴胆汁性肝硬化14例,原发性肝硬化失代偿1例,糖原累积症2例.术中14例供肝为全肝,1例供肝为左半肝,2例供肝为劈离肝,均无重要血管及胆道损伤.供体吻合动脉直径0.2～0.5 cm,受体吻合动脉直径0.2～0.4 cm.结果术后6例发生肝动脉血栓(hepatic artery thrombosis,HAT),经介入或再次肝动脉吻合及微动脉插管持续尿激酶灌注后恢复供血,其中2例分别于术后21d及7d死于严重肺部肺炎克雷白杆菌感染,1例术后7d死于肝动脉血栓形成,1例术后5d死于严重毛细血管渗漏综合征,1例术后23 d死于肠漏后感染性休克,1例术后1d死于因凝血功能严重障碍所致的失血性休克,其余11例顺利出院,健康生活至今.结论儿童DCD供肝肝移植术后肝动脉血栓发生率较高,有效的选择肝动脉支进行吻合及良好的动脉吻合技术可以降低肝动脉血栓发生率,对肝动脉栓塞的可疑患儿行剖腹探查、肝动脉介入造影检查及溶栓治疗可有效诊断和治疗肝动脉血栓.
목적 탐토진일보강저인동심장사망기관연헌(DCD)공간간이식술후간동맥병발증적조시.방법 회고성분석2011년7월지2014년4월아원완성적17례인동DCD공간간이식림상자료.본조공간부합DCD기관연헌표준,균유중국인체기관분배여공향계통(COTRS)분배.본조17례수자중담도폐쇄반담즙성간경화14례,원발성간경화실대상1례,당원루적증2례.술중14례공간위전간,1례공간위좌반간,2례공간위벽리간,균무중요혈관급담도손상.공체문합동맥직경0.2～0.5 cm,수체문합동맥직경0.2～0.4 cm.결과 술후6례발생간동맥혈전(hepatic artery thrombosis,HAT),경개입혹재차간동맥문합급미동맥삽관지속뇨격매관주후회복공혈,기중2례분별우술후21d급7d사우엄중폐부폐염극뢰백간균감염,1례술후7d사우간동맥혈전형성,1례술후5d사우엄중모세혈관삼루종합정,1례술후23 d사우장루후감염성휴극,1례술후1d사우인응혈공능엄중장애소치적실혈성휴극,기여11례순리출원,건강생활지금.결론 인동DCD공간간이식술후간동맥혈전발생솔교고,유효적선택간동맥지진행문합급량호적동맥문합기술가이강저간동맥혈전발생솔,대간동맥전새적가의환인행부복탐사、간동맥개입조영검사급용전치료가유효진단화치료간동맥혈전.
Objective To explore the measures of further reducing hepatic artery complications after donation-after-cardiac death (DCD) liver transplantation in children.Methods Retrospective analyses were conducted for clinical data of 17 children undergoing DCD liver transplantation from July 2011 to April 2014.They fulfilled the relevant standards by Chinese Human Organ Allocation & Sharing System (COTRS).The primary diseases of 17 recipients were biliary atresis (BA) with biliary cirrhosis (n=14),primary cirrhosis (n =1) and glycogen storage disease (n =2).And the donor liver was whole (n =14),left-sided (n =1) and split-off (n =2).There was no significant vascular or biliary injury.The donor anastomotic artery diameter was 0.2-0.5 cm and recipient anastomotic artery diameter 0.2-0.4 crn.Results Among 6 cases of postoperative hepatic artery thrombosis (HAT),2 died of severe lung infection of Klebsiella pneumoniae after 21 and 7 days.And the mortality causes were hepatic artery thrombosis after 7 days,severe capillary leak syndrome after 5 days,hindgut drain septic shock after 23 days and coagulation disorder leading to severe hemorrhagic shock after 1 day respectively.The remainder had a successful discharge and survived so far.Conclusions DCD liver transplantation has a higher incidence of hepatic artery thrombosis in children.And a proper selection of artery and meticulous anastomosis may reduce the incidence of hepatic artery thrombosis.Laparotomy is indicated for suspected patients.Arterial interventional examination and hepatic arteriography are effective in the diagnosis and treatment of hepatic artery thrombosis.