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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 ›› 2021, Vol. 10 ›› Issue (03) : 296 -300. doi: 10.3877/cma.j.issn.2095-3232.2021.03.013

所属专题： 文献；

临床研究

肝衰竭肝移植术后早期严重并发症相关因素分析
杨天池1, 王孟龙1,†()   
  1. 1. 100069　北京，首都医科大学附属北京佑安医院普通外科
  • 收稿日期:2021-03-02 出版日期:2021-06-10
  • 通信作者: 王孟龙

Risk factors of early severe complications after liver transplantation for liver failure

Tianchi Yang1, Menglong Wang1,†()   

  1. 1. Department of General Surgery, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
  • Received:2021-03-02 Published:2021-06-10
  • Corresponding author: Menglong Wang
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杨天池, 王孟龙. 肝衰竭肝移植术后早期严重并发症相关因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(03): 296-300.

Tianchi Yang, Menglong Wang. Risk factors of early severe complications after liver transplantation for liver failure[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 296-300.

目的

探讨肝衰竭肝移植术后早期严重并发症发生的相关危险因素。

方法

回顾性分析2004年1月至2013年12月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Clavien-Dindo分级，将术后1个月内发生Ⅲb级及以上并发症的患者定义为严重并发症组（41例），发生Ⅲb级以下并发症的患者定义为非严重并发症组（91例）。严重并发症发生相关因素的单因素分析采用t检验或χ2检验，多因素分析采用Logistic回归分析。

结果

单因素分析显示，术前MELD评分、术前血浆置换、冷缺血时间、边缘供体、手术方式、术中留置T管与肝衰竭肝移植术后患者早期严重并发症发生有关（χ2=4.425，5.069，5.672，4.105，6.352，6.293；P<0.05）。多因素Logistic回归分析显示，术前MELD评分≥25分、采用经典式肝移植术、术中留置T管为肝衰竭肝移植术后患者早期严重并发症发生的独立危险因素（OR=3.202，4.510，3.047；P<0.05），而术前血浆置换为其独立保护因素（OR=0.330，P<0.05）。

结论

术前MELD评分≥25分、采用经典式肝移植术及术中留置T管的肝衰竭肝移植术后患者更易发生早期严重并发症，而术前进行血浆置换患者其发生率较低。

关键词: 肝移植, 肝功能衰竭, 手术后并发症, 危险因素, Clavien-Dindo分级
Objective

To explore the risk factors of early severe complications in patients with liver failure after liver transplantation.

Methods

Clinical data of 132 patients with liver failure who initially underwent orthotopic liver transplantation in Beijing You'an Hospital, 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. According to the Clavien-Dindo classification, patients with early postoperative complications of grade Ⅲb or above were assigned into the severe complication group (n=41), and those with complications below grade Ⅲb were allocated into the non-severe complication group (n=91). Univariate analysis of the risk factors of severe complications was performed by t test or Chi-square test. Multivariate analysis was conducted by Logistic regression analysis.

Results

Univariate analysis showed that preoperative MELD score, preoperative plasma exchange, cold ischemia time, marginal donor, surgical pattern and intraoperative T-tube indwelling were significantly correlated with the incidence of early severe complications after liver transplantation for liver failure (χ2=4.425, 5.069, 5.672, 4.105, 6.352, 6.293; P<0.05). Multivariate Logistic regression analysis demonstrated that preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling were the independent risk factors for early severe complications after liver transplantation in patients with liver failure (OR=3.202, 4.510, 3.047; P<0.05), and preoperative plasma exchange was an independent protective factor (OR=0.330, P<0.05).

Conclusions

Preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling are more likely to cause early severe complications in liver failure patients after liver transplantation, whereas preoperative plasma exchange can lower the risk of early severe complications.

Key words: Liver transplantation, Liver failure, Postoperative complications, Risk factors, Clavien-Dindo classification
表1 肝衰竭肝移植术后患者并发症Clavien-Dindo分级
分级 相关并发症 例数
Ⅱ级 肺部感染、尿路感染、切口感染、胆道感染、腹腔渗血、上消化道出血、贫血、低蛋白血症、肾功能不全、排斥反应等 58
Ⅲa级 需要非全麻下行胸腔积液穿刺、ERCP胆道支架置入或ENBD引流、肝脏穿刺、骨髓穿刺、切口清创等处理的并发症 33
Ⅲb级 腹腔出血、胆漏、胆道梗阻 6
Ⅳ级 急性肾衰竭、呼吸衰竭、感染中毒性休克 14
Ⅴ级 MODS致死亡 21
表2 影响肝衰竭肝移植术后患者严重并发症发生的单因素分析
参数 严重并发症组 非严重并发症组 统计值 P值
性别（例，男/女） 33/8 76/15 χ2=0.180 0.671
年龄（岁,±s） 43±7 47±10 t=-0.608 0.546
肝衰竭病因（例，1/2/3）a 35/5/1 81/10/0 - 0.403
肝衰竭分型（例，1/2/3）b 8/28/5 9/65/17 χ2=1.933 0.380
术前MELD（例，0/1）c 13/28 46/45 χ2=4.425 0.014
术前血浆置换（例，无/有） 22/19 30/61 χ2=5.069 0.024
冷缺血时间（例，1/2）d 20/21 64/27 χ2=5.672 0.017
边缘供体（例，是/否） 24/17 36/55 χ2=4.105 0.043
手术时间（min，±s） 514±62 527±84 t=-0.894 0.373
无肝期（min，±s） 75±20 80±16 t=-1.399 0.167
术中出血量（ml，±s） 2 471±1 322 3 076±1 862 t=-1.874 0.063
术中输红细胞量（ml，±s） 2 014±949 2 141±1 179 t=-0.607 0.545
手术方式（例，1/2/3）e 13/20/8 12/58/21 χ2=6.352 0.042
术中留置T管（例，无/有） 19/22 63/28 χ2=6.293 0.012
表3 影响肝衰竭肝移植术后患者严重并发症发生的多因素Logistic回归分析
变量 b SE（b） Wald χ2值 P值 OR值 95%CI
冷缺血时间>12 h 1.220 0.817 2.230 0.135 3.386 1.503～4.326
边缘供体 -0.038 0.797 0.002 0.962 0.963 0.426～1.357
MELD评分≥25分 1.164 0.460 6.399 0.011 3.202 1.300～7.890
血浆置换 -1.109 0.456 5.917 0.015 0.330 0.135～0.806
手术方式a     6.596 0.037    
  经典式 1.506 0.696 4.689 0.030 4.510 1.154～17.632
  背驮式 0.204 0.575 0.126 0.722 1.227 0.153～5.647
术中留置T管 1.114 0.477 5.457 0.019 3.047 1.196～7.759
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