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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 (06): 584 -588. doi: 10.3877/cma.j.issn.2095-3232.2021.06.011

临床研究

保留供肝胃十二指肠动脉对肝移植术后胆道并发症的影响
陈焕伟1,†(), 刘颖1, 廖珊2, 邓斐文1, 王峰杰1   
  1. 1. 528000　广东省佛山市第一人民医院肝脏外科
    2. 528000　广东省佛山市第一人民医院统计室
  • 收稿日期:2021-07-20 出版日期:2021-09-23
  • 通信作者: 陈焕伟
  • 基金资助:
    广东省基础与应用基础研究基金联合基金重大项目(2020B1515120031); 佛山市登峰计划器官移植技术创新平台项目基金(2020A007)

Effect of preserving gastroduodenal artery of liver graft on biliary complications after liver transplantation

Huanwei Chen1,†(), Ying Liu1, Shan Liao2, Feiwen Deng1, Fengjie Wang1   

  1. 1. Department of Hepatobiliary Surgery, the First People's Hospital of Foshan, Foshan 528000, China
    2. Statistics Office, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2021-07-20 Published:2021-09-23
  • Corresponding author: Huanwei Chen
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目的

探讨保留供肝胃十二指肠动脉的改良供肝修剪方法对肝移植受者术后胆道并发症的影响。

方法

回顾性分析2011年9月至2019年11月在佛山市第一人民医院行原位肝移植的129例受者临床资料。其中男120例，女9例；年龄31~71岁，中位年龄50岁。受者均签署知情同意书，符合医学伦理学规定。根据供肝修剪方法，将受者分为改良组（56例）和常规组（73例）。改良组技术要点是保留胃十二指肠动脉远端至少2 cm，特别注意保留胰十二指肠上动脉后支以及变异的肝右动脉，以保证胆总管远端血供。观察两组肝移植围手术期情况。两组手术时间比较采用t检验，术后住院时间比较采用Mann-Whitney U检验，术后胆道并发症发生率比较采用χ2检验。

结果

改良组平均手术时间为（7.4±1.2）h，明显少于常规组的（8.0±1.3）h（t=-2.524，P<0.05）。改良组术后住院时间分别为16（14）d，明显少于常规组的22（11）d（Z=2.970，P<0.05）。改良组术后胆道并发症发生率为5%（3/56），明显低于常规组的21%（15/73） （χ2=6.091，P<0.05）。

结论

保留供肝胃十二指肠动脉的改良修肝方法可保持胰十二指肠上后动脉及周围组织的完整性，有利于保护肝外胆管的血供，降低肝外胆管缺血所导致的肝移植术后胆道并发症发生率。

关键词: 肝移植, 胆道并发症, 活体供者, 胃十二指肠动脉
Objective

To evaluate the effect of modified liver graft repairing method, preserving the gastroduodenal artery of graft on the biliary complications after liver transplantation.

Methods

Clinical data of 129 recipients undergoing orthotopic liver transplantation in the First People's Hospital of Foshan from September 2011 to November 2019 were retrospectively analyzed. Among them, 120 patients were male and9 female, aged from 31 to 71 years, with a median age of 50 years. The informed consents of all recipients were obtained and the local ethical committee approval was received. According to different liver graft repairing methods, all recipients were divided into the modified group (n=56) and conventional group (n=73). In the modified group, at least 2 cm of the distal end of gastroduodenal artery was reserved, especially the posterior branch of superior pancreaticoduodenal artery and the variant right hepatic artery, to guarantee the distal blood supply of common bile duct. Perioperative conditions of the recipients were observed intwo groups. The operation time between two groups was compared by t test. The length of postoperative hospital stay was compared by Mann-Whitney U test. The incidence of postoperative biliary complications was compared by Chi-square test.

Results

The average operation time in the modified group was (7.4±1.2) h, significantly shorter than (8.0±1.3) h in the conventional group (t=-2.524, P<0.05). The length of postoperative hospital stay in the modified group was 16(14) d, significantly shorter than 22(11) d in the conventional group (Z=2.970, P<0.05). The incidence of postoperative biliary complications in the modified group was 5%(3/56), significantly lower than 21%(15/73) in the conventional group (χ2=6.091, P<0.05).

Conclusions

The modified liver graft repairing method with reserved gastroduodenal artery can maintain the integrity of the superior posterior pancreaticoduodenal artery and its surrounding tissues, which is beneficial to protect the blood supply of extrahepatic bile duct and reduce the incidence of biliary complications caused by extrahepatic bile duct ischemia after liver transplantation.

Key words: Liver transplantation, Biliary complication, Living donors, Gastroduodenal artery
表1 改良组和常规组肝移植受者一般资料比较
组别 例数 年龄（岁，±s） 性别（男/女，例） BMI（kg/m2，±s） MELD评分[分，M（QR）] 原发病（例）
肝炎后肝硬化 原发性肝癌 酒精性肝硬化 免疫性肝病 肝豆状核变性 多囊肝
改良组 56 52±10 50/6 24±4 12(17) 22 32 1 1 0 0
常规组 73 49±9 70/3 23±3 12(11) 37 28 5 1 1 1
统计值   t=1.786 χ2=1.234 t=0.872 Z=0.131 -
P值   0.076 0.267 0.385 0.896 0.275
表2 改良组和常规组肝移植受者手术情况比较
组别 例数 手术时间（h，±s） 热缺血时间[min，M（QR）] 冷缺血时间[h，M（QR）] 无肝期时间（min，±s） 第二热缺血时间[min，M（QR）] 术中出血量[ml，M（QR）]
改良组 56 7.4±1.2 0（5） 5.0（2.3） 61±11 60（34） 3 100（3 200）
常规组 73 8.0±1.3 0（6） 5.0（1.9） 63±14 59（47） 4 000（4 250）
统计值   t=-2.524 Z=-1.492 Z=0.660 t=-0.762 Z=0.378 Z=-1.241
P值   0.013 0.136 0.509 0.448 0.706 0.214
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