无心跳供肝发生胆道严重缺血性病变的危险因素分析

Analysis of risk factors for severe ischemic biliary lesions in liver grafts from non-heart-beating donors

目的探讨无心跳供肝发生严重胆道缺血性病变的危险因素。方法北京朝阳医院2002年7月至2006年6月实施的同种异体原位肝移植病例中排除肝肾联合移植、二次肝移植、供受体AB0血型不符病例，统计入选病例131例，术后随访时间均〉180d。排除混杂因素后采用Logistic回归分析缺血再灌注相关性严重胆道并发症的危险因素。结果无心跳供肝胆道二次热缺血时间〉60min是术后严重缺血性胆道并发症的独立危险因素。热缺血与冷保存协同作用于供肝，单独或同时延长热缺血、冷保存时间，术后严重缺血性胆道并发症发生率增高。结论无心跳供肝热缺血或冷保存时间延长的协同作用以及胆道二次热缺血时间〉60min是肝移植术后严重缺血性胆道并发症的危险因素。将热缺血时间带人拟合直线回归方程可预知冷保存时间的相对“安全”时限。

Objective To investigate the risk factors for severe ischemic biliary lesions in liver grafts from non-heart beating donors. Methods The liver transplantations from non heart-beating donors performed in Beijing Chaoyang Hospital from July 2002 to June 2006 were reviewed. After exclusion of the cases of combined liver and renal transplantations, retransplantations and ABO blood group imcompatibility between donors and recipients, a total of 131 patients who were followed up to 180 days after liver transplantations were retrospectively analyzed. Excluding other influencing factors, risk factors of biliary complication were analyzed by stepwise logistic regression. Results The second bile duct warm ischemia time longer than 60 minutes was an independent risk factor for the severe ischemic biliary complication. The simultaneous or independent prolonged cold and warm ischemia time significantly increased the incidence of severe biliary complications. Conclusions The second bile duct warm ischemia time longer than 60 minutes and synergistic effect of the warm and cold ischemia time are risk factors for the severe biliary complication after liver transplantations from non heart-beating donors.