探讨术前断流术和消化道出血对肝硬化门静脉高压症患者肝移植疗效的影响。

回顾性分析2005年1月至2015年12月在解放军联勤保障部队第九○○医院行肝移植的110例肝硬化门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男84例，女26例；年龄7～75岁，中位年龄46岁。根据术前有无断流术史和消化道出血史，将患者分为断流组（19例），非断流组（91例）及出血组（66例），非出血组（44例）。分析术前断流术及消化道出血对患者预后的影响。两组术中出血量、输液量等比较采用t检验，率的比较采用χ²检验。

断流组患者术后并发症发生率和5年累积生存率分别为42%、74%，明显高于非断流组的19%、88%（χ²=4.91，2.56；P<0.05）。断流组术中出血量、输液量、手术时间、住院费用分别为（4 135±2 696）ml、（11 068±3 461）ml、（511±126）min、（28±9）万元，明显高于非断流组的（3 202±1 122）ml、（7 275±2 346）ml、（396±85）min、（24±5）万元（t=2.46，6.36，4.90，2.71；P<0.05）。出血组和非出血组上述指标比较，差异均无统计学意义（P>0.05）。

术前断流术增加肝硬化门静脉高压症患者肝移植的难度,术后风险高，而消化道出血对肝移植疗效无明显影响。

To evaluate the effect of preoperative devascularization and the impact of gastrointestinal hemorrhage on the efficacy of liver transplantation for cirrhotic portal hypertension patients.

Clinical data of 110 patients with cirrhotic portal hypertension undergoing liver transplantation in the 900^th Hospital of PLA Joint Logistics Support Force from January 2005 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 26 female, aged 7-75 years with a median of 46 years. According to the history of preoperative devascularization and gastrointestinal hemorrhage, the patients were divided into the devascularization (n=19) and non-devascularization (n=91) groups, hemorrhage (n=66) and non-hemorrhage groups (n=44). The effect of preoperative devascularization and gastrointestinal hemorrhage on prognosis of patients was evaluated. Intraoperative blood loss and infusion volume between two groups were compared by t test. The rate comparison was performed by Chi-square test.

The incidence of postoperative complications and the 5-year cumulative survival rate in devascularization group were 42% and 74%, significantly higher than 19% and 88% in non-devascularization group (χ²=4.91, 2.56; P<0.05). In devascularization group, intraoperative blood loss, infusion volume, operation time and hospitalization expense were (4 135±2 696) ml, (11 068±3 461) ml, (511±126) min, (280±90)×10³ Yuan, respectively, significantly higher than (3 202±1 122) ml, (7 275±2 346) ml, (396±85) min, (240±50)×10³ Yuan in non-devascularization group (t=2.46, 6.36, 4.90, 2.71; P<0.05). No significant difference was observed between the hemorrhage and non-hemorrhage groups (all P>0.05).

Preoperative devascularization increases the difficulty of liver transplantation for cirrhotic portal hypertension patients and yields high postoperative risk. Nevertheless, gastrointestinal hemorrhage exerts no significant impact upon the efficacy of liver transplantation.