小儿肝移植术后门静脉血流量对移植肝功能的影响

Influence of Portal Vein Flow on Graft Function after Pediatric Liver Transplantation

目的 探讨小儿肝移植术后可能出现的门静脉血流过量对移植物功能的影响。方法 2004年11月～2005年9月施行小儿肝移植术4例，其中先天性门静脉海绵样变伴门静脉高压2例，巨大肝母细胞瘤1例，先天性胆道闭锁1例。彩色多普勒超声测量门静脉和肝动脉血流量，并监测肝功能变化。结果 4例患儿移植物质量与患儿体质量之比（GW／RW）分别为1．24％、1．12％、2．1％和3．29％。1例先天性门静脉海绵样变伴门静脉高压患儿（GW／RW为1．12％），术后门静脉血流量大幅上升（GW／RW为1，12％），其血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）均明显升高，同时肝动脉血流量明显减小；该例与另外3例比较，上述指标均有显著差异（P＜0．05）。结论 肝移植术后门静脉血流量大幅度增加对移植肝功能有相当程度损害。肝动脉血流量伴随门静脉血流量的增加有相应下降。

Objective To discuss the influence of the graft caused by the overflow of the portal vein after liver transplantation. Methods Four pediatric liver transplantations were performed from November 2004 to August 2005 on whom suffered from congenital biliary atresia（one case） , hepatoblastoma （one case）and portal hypertension caused by cavernous transformation（two cases）. Results The ratios of graft weight to receptor weight （GW/RW） of these four cases were 1.24% , 1.12% , 2.1% and 3.29% , respectively. The portal flow was significantly increased in one case （GW/RW = 1.12% ） , while the hepatic artery flow was decreased remarkably. Correspondingly, the serum levels of alanine transferase （ALT） and aspartate aminotransferase （AST） were elevated strikingly. However, the portal vein flow, hepatic artery flow and graft function of the other three cases changed moderately. Conclusion The graft function in the receptor was impaired by the overflow of the portal vein. The hepatic artery flow decreases with the increase of the portal vein flow.