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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 489 -492. doi: 10.3877/cma.j.issn.2095-3232.2019.06.006

所属专题： 文献；

临床研究

采用Clavien-Dindo分级系统分析不同肝移植术式对肝衰竭患者术后早期严重并发症的影响
杨天池1, 王孟龙1,†()   
  1. 1. 100069　首都医科大学附属北京佑安医院普通外科
  • 收稿日期:2019-09-18 出版日期:2019-12-10
  • 通信作者: 王孟龙

Effects of different liver transplantations on postoperative early severe complications in liver failure patients: analysis using Clavien-Dindo classification

Tianchi Yang1, Menglong Wang1,†()   

  1. 1. Department of General Surgery, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
  • Received:2019-09-18 Published:2019-12-10
  • Corresponding author: Menglong Wang
  • About author:
    Corresponding author: Wang Menglong, Email:
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杨天池, 王孟龙. 采用Clavien-Dindo分级系统分析不同肝移植术式对肝衰竭患者术后早期严重并发症的影响[J]. 中华肝脏外科手术学电子杂志, 2019, 08(06): 489-492.

Tianchi Yang, Menglong Wang. Effects of different liver transplantations on postoperative early severe complications in liver failure patients: analysis using Clavien-Dindo classification[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(06): 489-492.

目的

采用Clavien-Dindo分级系统分析不同肝移植术式对肝衰竭患者术后并发症发生率的影响。

方法

回顾性分析2004年1月至2013年12月在首都医科大学附属北京佑安医院首次接受同种异体原位肝移植术的132例肝衰竭患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男109例，女23例；平均年龄（44±10）岁。根据不同手术方式将患者分为3组：经典组（25例）、经典转流组（29例）、背驮组（78例）。采用Clavien-Dindo分级系统对患者术后并发症进行分级，Ⅲb级及以上并发症为术后早期严重并发症。并发症发生率比较采用χ2检验。

结果

肝移植术后早期严重并发症发生率为31%（41/132），其中Ⅲb、Ⅳ、Ⅴ级并发症分别为6、14、21例。经典组、转流组、背驮组术后早期严重并发症发生率分别为52%（13/25）、28%（8/29）、26%（20/78），差异有统计学意义（χ2=6.352，P<0.05），其中背驮组明显低于经典组（χ2=6.041，P<0.017）。

结论

不同肝移植术式对肝衰竭患者术后并发症发生率有影响，背驮式肝移植术后早期严重并发症发生率较低。

关键词: 肝移植, 手术方式, 术后并发症, Clavien-Dindo分级
Objective

To evaluate the effects of different liver transplantation approaches on the incidence of postoperative complications in patients with liver failure using Clavien-Dindo classification.

Methods

Clinical data of 132 patients with liver failure who underwent orthotopic liver transplantation for the first time in Beijing You'an Hospital Affiliated to Capital Medical University from January 2004 to December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 109 patients were male and 23 female, aged (44±10) years on average. All the patients were divided into the classic group (n=25), classical venous bypass group (n=29) and piggyback group (n=78). Postoperative complications were graded by Clavien-Dindo classification, Postoperative complications of Ⅲb and above were defined as the severe complications early after liver transplantation. The incidence of postoperative complications was compared by Chi-square test.

Results

The incidence of severe complications early after liver transplantation was 31%(41/132). Grade Ⅲb, Ⅳ and Ⅴ complications were observed in 6, 14 and 21 cases, respectively. The incidence of severe complications early after liver transplantation in the classic, classical bypass and piggyback groups were 52%(13/25), 28%(8/29) and 26%(20/78) , respectively, with significant differences were observed (χ2=6.352, P<0.05). The incidence of severe complications in piggyback group was significant lower than that in classic group (χ2=6.041, P<0.017).

Conclusions

Different liver transplantation approaches exert effects upon the incidence of postoperative complications in patients with liver failure. The incidence of severe complications early after piggyback liver transplantation is relatively low.

Key words: Liver transplantation, Technique of operation, Postoperative complications, Clavien-Dindo classification
表1 经典组、转流组和背驮组肝衰竭肝移植患者一般情况比较（±s）
组别 例数 年龄（岁，±s ） 性别（例） 肝衰竭分型（例） 肝衰竭病因（例）
男 女 急性 亚急性 慢性 混合型 病毒性 酒精性 药物性
经典组 25 45±8 22 3 2 2 6 15 22 3 0
转流组 29 45±16 23 6 1 5 3 20 25 4 0
背驮组 78 45±10 65 13 1 6 13 58 69 8 1
统计值 ? F=0.064 χ2=0.073 χ2=6.973 χ2=0.948
P值 ? 0.938 0.694 0.323 0.918
表2 经典组、转流组和背驮组肝衰竭肝移植患者术中情况比较
? 例数 手术时间（min，±s ） 无肝期（min，±s ） 术中出血量[ml，M(QR)] 术中输红细胞量[ml，M(QR)]
经典组 25 557±103 92±24 3 000（700～8 500） 2 400（800～5 200）
转流组 29 527±78 81±17 2 500（200～14 000） 1 600（400～7 000）
背驮组 78 554±118 91±21 2 300（450～750） 2 000（0～5 400）
统计值 ? F=0.424 F=1.313 H=4.350 H=3.218
P值 ? 0.655 0.273 0.124 0.200
表3 经典组、转流组和背驮组肝衰竭肝移植患者术后早期严重并发症发生率比较[例（%）]
? 例数 Ⅲb级 Ⅳ级 Ⅴ级 合计
经典组 25 1（4） 4（16） 8（32） 13（52）
转流组 29 2（7） 3（11） 3（10） 8（28）
背驮组 78 3（4） 7（9） 10（13） 20（26）
χ2值 ? 0.475 0.998 6.066 6.352
P值 ? 0.798 0.610 0.048 0.042
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