CAJ | 학술논문

目的分析和评价儿童劈离式肝移植的效果.方法回顾性分析2006年9月至2014年12月间210例儿童活体肝移植和劈离式肝移植的临床资料,对儿童活体肝移植和劈离式肝移植的预后及影响因素进行了总结分析.根据肝移植手术方式的不同,将210例受者分为活体组和劈离组.(1)活体组:183例受者,所有供者均为受者3代以内的直系亲属;(2)劈离组:27例,所有供者均为男性,22例供肝来源于无心跳供者.术后均采用他克莫司联合甲泼尼龙的二联免疫抑制方案.观察和比较两组受者术后存活情况及并发症发生情况.结果劈离组供肝均取自男性供者,与活体组供者的性别比存在显著差异(P＜0.05),且供肝冷缺血时间亦明显长于活体组(P＜0.05).210例受者术后1个月、6个月、1年及2年的总体存活率分别为99.5％、98.1％、96.2％和94.2％.活体组和劈离组受者术后随访时间中位数分别为15.2个月和26.1个月,活体组术后1个月、6个月、1年和2年的存活率分别为99.5％、96.7％、92.6％和74.1％,劈离组分别为97.8％、96.2％、77.8％和74.0％,两组间比较差异均有统计学意义(P=0.001).随访期间,劈离组死亡8例(29.6％),其中5例死于感染及败血症,3例死于多器官功能衰竭;活体组死亡10例(5.5％),其中6例死于感染和败血症,4例死于多器官功能衰竭.结论在严格选择供者的情况下,儿童劈离式肝移植可以获得良好效果;但劈离式肝移植术后并发症发生率较活体肝移植高,尤其是胆道并发症的发病率,应积极防范及处理.
목적 분석화평개인동벽리식간이식적효과.방법 회고성분석2006년9월지2014년12월간210례인동활체간이식화벽리식간이식적림상자료,대인동활체간이식화벽리식간이식적예후급영향인소진행료총결분석.근거간이식수술방식적불동,장210례수자분위활체조화벽리조.(1)활체조:183례수자,소유공자균위수자3대이내적직계친속;(2)벽리조:27례,소유공자균위남성,22례공간래원우무심도공자.술후균채용타극막사연합갑발니룡적이련면역억제방안.관찰화비교량조수자술후존활정황급병발증발생정황.결과 벽리조공간균취자남성공자,여활체조공자적성별비존재현저차이(P＜0.05),차공간랭결혈시간역명현장우활체조(P＜0.05).210례수자술후1개월、6개월、1년급2년적총체존활솔분별위99.5％、98.1％、96.2％화94.2％.활체조화벽리조수자술후수방시간중위수분별위15.2개월화26.1개월,활체조술후1개월、6개월、1년화2년적존활솔분별위99.5％、96.7％、92.6％화74.1％,벽리조분별위97.8％、96.2％、77.8％화74.0％,량조간비교차이균유통계학의의(P=0.001).수방기간,벽리조사망8례(29.6％),기중5례사우감염급패혈증,3례사우다기관공능쇠갈;활체조사망10례(5.5％),기중6례사우감염화패혈증,4례사우다기관공능쇠갈.결론 재엄격선택공자적정황하,인동벽리식간이식가이획득량호효과;단벽리식간이식술후병발증발생솔교활체간이식고,우기시담도병발증적발병솔,응적겁방범급처리.
Objective To analyze and evaluate the efficay of split liver transplantation in children.Method From September 2006 to December 2014,210 children were treated with liver transplantation in Tianjin First Central Hospital.The clinical data were retrospectively analyzed and the difference in postoperative survival was compared between the groups.The 210 childrens were categorized into living donor liver transplantation group (183 cases) and split liver transplantation group (27 cases) based on their operation styles.In living group,all donors to recipients were immediate relatives within three generations.In split group,all donors were men,and livers were obtained from no heartbeat donors.Postoperatively,tacrolimus combined a duplex of prednisolone served as immunosuppression scheme.The survival and incidence of complications were observed.Result There was significant difference in the sex ratio between two groups (P＜0.05).The donor liver cold ischemia time was significantly longer in split group than in living group (P＜0.05).The 1-month,6-month,1-year and 2-year overall survival rate in 210 recipients was 99.5％,98.1％,96.2％ and 94.2％ respectively.The median follow-up time in living group and split group was 15.2months and 26.1 months,respectively.The 1-mont,6-month,1-year and 2-year survival rate was 99.5％,96.7％,92.6％ and 74.1 ％ in living group,and 97.8％,96.2％,77.8％ and 74.0％ in split group,respectively (P＜0.05).During the follow-up period,8 cases died (29.6％) in split group (5deaths due to infection and sepsis,and 3 deaths due to multiple organ failure),and 10 cases died (5.5％) in living group (6 deaths due to infection and sepsis,and 4 deaths due to multiple organ failure).Conclusion In the case of strict selection of donors,split liver transplantation can obtain good effect,but the incidence of complications is higher than living donor liver transplantation.Especially,the biliary complications should be prevented and managed actively.