CAJ | 학술논문

目的总结儿童活体肝脏移植(PLDLT)临床经验,提高治疗效果.方法对武警总医院2005年4月至2014年4月进行的45例PLDLT患者手术前及随访资料进行回顾分析.结果全部供者术后均顺利恢复.移植物重量和受者体重比(GRWR)为1.0％～6.4％(2.5％±1.2％).供肝切取后行减体积移植2例,因门静脉短间置血管搭桥1例,采用血管搭桥引流肝断面Ⅴ、Ⅷ段肝静脉3例,采用血管补片辅助重建肝左静脉2例,超声多普勒显示肝动脉血流不良术中再次重建肝动脉3例.术后出现排异反应2例、血管并发症7例、胆道并发症11例、感染并发症27例.45例受者中3例死于血管并发症,4例死于感染,其余38例随访至今生活质量良好,1年、2年、5年存活率均为84.4％.比较术后存活组与死亡组年龄[(50.8±49.8)个月比(12.6±14.9)个月]、体重[(16.2±10.5) kg比(7.3±1.7)kg]、术前胆红素水平[(177.0±126.5)μmol/L比(301.9±110.6)μmol/L]、儿童终末期肝病(PELD)评分[(16.1±12.1)分比(26.2±11.3)分]和GRWR比值(2.2％±0.8％比4.2％±1.6％),两组差异有统计学意义(P＜0.05).结论通过综合措施充分改善患者的术前状况,降低相关危险因素,提高手术技术,合理的术后管理,有利于改善预后.
목적 총결인동활체간장이식(PLDLT)림상경험,제고치료효과.방법 대무경총의원2005년4월지2014년4월진행적45례PLDLT환자수술전급수방자료진행회고분석.결과 전부공자술후균순리회복.이식물중량화수자체중비(GRWR)위1.0％～6.4％(2.5％±1.2％).공간절취후행감체적이식2례,인문정맥단간치혈관탑교1례,채용혈관탑교인류간단면Ⅴ、Ⅷ단간정맥3례,채용혈관보편보조중건간좌정맥2례,초성다보륵현시간동맥혈류불량술중재차중건간동맥3례.술후출현배이반응2례、혈관병발증7례、담도병발증11례、감염병발증27례.45례수자중3례사우혈관병발증,4례사우감염,기여38례수방지금생활질량량호,1년、2년、5년존활솔균위84.4％.비교술후존활조여사망조년령[(50.8±49.8)개월비(12.6±14.9)개월]、체중[(16.2±10.5) kg비(7.3±1.7)kg]、술전담홍소수평[(177.0±126.5)μmol/L비(301.9±110.6)μmol/L]、인동종말기간병(PELD)평분[(16.1±12.1)분비(26.2±11.3)분]화GRWR비치(2.2％±0.8％비4.2％±1.6％),량조차이유통계학의의(P＜0.05).결론 통과종합조시충분개선환자적술전상황,강저상관위험인소,제고수술기술,합리적술후관리,유리우개선예후.
Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.