中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (12): 1050-1052.

• 论著 • 上一篇    下一篇

肝移植术后缺血性胆道并发症危险因素及预防研究

杨德君，张海斌，赵文超，杨广顺   

  1. 第二军医大学附属东方肝胆外科医院胆道二科，上海200438
  • 出版日期:2010-12-01 发布日期:2010-11-25

  • Online:2010-12-01 Published:2010-11-25

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摘要：

目的    探讨肝移植术后缺血性胆道并发症(ischemic-type biliary complication，ITBC)的预防方法。方法 对第二军医大学附属东方肝胆外科医院2006-2010年181例肝移植病人的术后资料进行回顾分析，通过对发生ITBC病人进行Clavien分级，逐步回归法筛选ITBC发生的危险因素。 结果    6.08%(11/181)肝移植病人发生ITBC，其Clavien分级均在Ⅲb级以上。对ITBC组进行回归分析表明：术后1d肝动脉阻力指数（RI1d）（P=0.0500，OR=0.916），术后1周肝动脉阻力指数（RI1w）（P=0.0078，OR>999.999）的差异有统计学意义，且对该疾病的发生作用显著。结论    缺血性胆道并发症预后不佳，术后肝动脉血流异常是ITBC发生的独立危险因素。提高动脉吻合技术，保持动脉血流通畅有利于预防ITBC的发生。

关键词: 缺血性胆道并发症, 危险因素, 预防

Abstract:

Analysis of risk factors and prevention for ischemic-type biliary tract complication following liver transplantation        YANG De-jun, ZHANG Hai-bin, ZHAO Wen-chao,et al.The Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Hospital, the Second Military Medical University,Shanghai 200438,China 
Corresponding author：YANG Guang-shun，E-mail：gs_yang00@yahoo.com
Abstract   Objective To explore the risk factors contributing to the development of the ischemic-type biliary complication(ITBC) and the prevention of ITBC in a large subjects undergoing liver transplantations(LT) retrospectively. Methods    The ischemic-type biliary complication cases were classified with Clavien system. The risk factors of ITBC were evaluated by using a binary forward stepwise logistic regression analysis. Results    6.08%(11/181,ITBC group) recipients developed ITBC, all of the cases are BC above ClavienⅢb. Regression analysis of ITBC revealed that RI1d（P=0.0500,OR=0.916）, RI1w（P=0.0078,OR>999.999）had significant difference and contributed more to the development of ITBC. Conclusion    ITBC have bad prognosis. Hepatic arterial insufficiency(HAI) was an independent risk factor for ITBC. Modification of arterial construction technique can reduce incidence of ITBC, to keep hepatic artery fluent have the same values.

Key words: ischemic-type biliary complication, risk factors, prevention