背驮式与经典非转流式肝移植围术期临床疗效的研究

doi:10.3969/j.issn.1006-7795.2020.06.014

首都医科大学学报 ›› 2020, Vol. 41 ›› Issue (6): 954-959.doi: 10.3969/j.issn.1006-7795.2020.06.014

背驮式与经典非转流式肝移植围术期临床疗效的研究

张菊霞, 吴安石^*

首都医科大学附属北京朝阳医院麻醉科, 北京 100020

收稿日期:2019-10-28 出版日期:2020-12-21 发布日期:2021-01-18
基金资助:
北京市医管局“扬帆计划”(ZYLX201822)。

Analysis of the perioperative clinical efficacy of piggyback and classical non-bypass liver transplantation

Zhang Juxia, Wu Anshi^*

Department of Anesthesiology,Beijing Chaoyang Hospital,Capital Medical University, Beijing 100020,China

Received:2019-10-28 Online:2020-12-21 Published:2021-01-18
Contact: * E-mail: wuanshi88@163.com
Supported by:
Yang Fan Program of Beijing Hospital Administration (ZYLX201822).

摘要/Abstract

摘要： 目的通过回顾性对比分析采用背驮式和经典非转流式肝移植两种术式的患者的临床资料,比较两种术式对肝移植患者围术期并发症及病死率的影响。方法收集3家临床医疗中心于2005年6月至2013年6月间完成肝移植手术的患者资料。将患者分为背驮式肝移植组和经典非转流式肝移植组两组。采用t检验、秩和检验和卡方检验来比较两组患者之间各指标的差异;采用重复测量方差分析探究两组之间围术期肌酐浓度的差异;采用二元Logistics回归方法分析术后病死率的危险因素。结果共纳入1 411例患者,其中背驮式肝移植组共纳入445例,经典非转流式肝移植组共966例。出院时死亡人数为54人,病死率为3.83%(54/1 411);两组患者围术期的肌酐浓度变化趋势差异无统计学意义(F=2.63,P=0.11),但在不同时间点之间肌酐浓度有明显变化(F=25.86,P=0.00);采用二元Logistics回归整体分析两种术式在出院时转归(死亡或生存)上差异无统计学意义(OR=0.679,P=0.231),对3个中心进行亚组分析显示,中心3中采用两种术式的患者在出院时转归上差异有统计学意义(OR=0.213;P=0.04)。进一步对中心3的数据进行二元Logistics回归分析显示,术式、术后发生血滤、肺部感染及肾衰竭均为术后死亡的危险因素。结论经典非转流术式组与背驮式肝移植组患者术后肌酐浓度均明显高于术前;术式、术后血滤、肺部感染及肾衰竭为肝移植围术期死亡的独立危险因素。

关键词: 背驮式肝移植, 经典非转流式肝移植, 肾功能, 病死率

Abstract: Objective The clinical data of piggyback liver transplantation and classical non-bypass liver transplantation were analyzed retrospectively to compare the efficacy of the two methods on perioperative complications and case fatality rate of liver transplantation patients. Methods Liver transplantation patients from three clinical medical centers between June 2005 and June 2013 were divided into two groups: piggyback liver transplantation group and classical non-bypass liver transplantation group. T test, rank sum test and chi square test were used to compare the differences of observation indexes between the two groups, and repeated measurement analysis of variance was used to explore the difference of creatinine concentration between the two groups during perioperative period. Binary Logistics regression were used to analyze the risk factors of postoperative case fatality rate. Results A total of 1 411 patients were recruied, including piggyback liver transplantation group (n=445) and classical non-bypass liver transplantation group (n=966). Totally 54 patients died at discharge, with a case fatality rate of 3.83%. The analysis of variance of repeated measurement showed that there was no significant difference in the change trend of creatinine concentration between the two groups during the perioperative period, but there was a significant change in creatinine concentration at different time points. The results of binary Logistics regression analysis showed that there was no significant difference inthe states of dischargebetween the two operations (OR=0.679, P=0.231), the opposite result appeared in the subgroup analysis in the center 3 (OR=0.213, P=0.004). Further analysis of the data of the center 3 by binary Logistics regression analysis showed that postoperative hemofiltration, pulmonary infection and renal failure were all risk factors of postoperative death. Conclusions The creatinine concentration after operation in both groups was significantly higher than that before operation. Postoperative hemofiltration, pulmonary infection and renal failure were independent risk factors for perioperative death of liver transplantation.

Key words: piggyback liver transplantation, classical non-bypass liver transplantation, renal function, case fatality rate

中图分类号:

R617

张菊霞, 吴安石. 背驮式与经典非转流式肝移植围术期临床疗效的研究[J]. 首都医科大学学报, 2020, 41(6): 954-959.

Zhang Juxia, Wu Anshi. Analysis of the perioperative clinical efficacy of piggyback and classical non-bypass liver transplantation[J]. Journal of Capital Medical University, 2020, 41(6): 954-959.

参考文献

[1] Maynard E. Liver transplantation: patient selection, perioperative surgical issues, and expected outcomes[J]. Surg Clin North Am,2019,99(1):65-72.
[2] Starzl T E. The long reach of liver transplantation[J]. Exp Clin Transplant,2013,11(2):87-92.
[3] 郑树森,梁廷波. 经典原位肝移植中的转流与非转流[J]. 消化外科,2002,1(4):229-229.
[4] 张秋艳,范林,叶啓发. 再论背驮式肝移植技术优良[J]. 中华消化外科杂志,2015,21(4):278-280.
[5] 刘洵,王赛楠,吴安石. 乳酸浓度和终末期肝病模型评分对肝移植术后早期死亡率预测准确性的比较[J]. 临床麻醉学杂志,2019,2(35):116-120.
[6] 叶啟发,明英姿,成柯. 背驮式肝移植及其改良技术的临床应用[J]. 中华消化外科杂志,2019,18(4):311-315.
[7] 叶啟发,赵杰,明英姿. 论经典背驮式肝移植技术[J]. 中华肝胆外科杂志,2013,19(1):1-3.
[8] 王维伟,陈国勇,孙建军. 经典式肝移植与背驮式肝移植手术的回顾性分析[J]. 中华临床医师杂志(电子版),2014,8(1):397-401.
[9] Nikeghbalian S, Toutouni M N, Salahi H, et al. A comparative study of the classic and piggyback techniques for orthotopic liver transplantation[J]. Electron Physician,2014,6(1):741-746.
[10]张达利,毕京峰,高银杰,等.肝移植术后患者急性肾损伤危险因素及严重程度分析[J].传染病信息,2019,32(5):411-414.
[11]郭瑞,李晓航,李峰,等.肝移植术中入肝血流量对术后早期移植物功能不全的临床意义[J].中国医科大学学报,2019,48(3):240-244.
[12]周林,郑永根,杜国盛,等.肝癌肝移植术后西罗莫司转换治疗的免疫学效应分析[J].解放军医药杂志,2017,29(4):24-28.
[13]Angarita S A K, Russell T A, Kaldas F M. Pneumonia after liver transplantation[J]. Curr Opin Organ Transplant,2017,22(4):328-335.
[14]岳竹,李昂,刘培. 肝移植术后急性肾损伤的发生率及危险因素[J]. 首都医科大学学报,2018,39(1):14-20.

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背驮式与经典非转流式肝移植围术期临床疗效的研究

Analysis of the perioperative clinical efficacy of piggyback and classical non-bypass liver transplantation

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