尿激酶灌注无心跳供肝预防肝内缺血型胆道病变的临床研究

Role of urokinase-perfused grafts in preventing intrahepatic ischemic biliary lesion in no-heart-beating donor

目的探讨降低无心跳尸体供体肝移植术后肝内缺血型胆道病变发生率的方法，进而减少再移植率，提高长期生存质量。方法针对无心跳尸体供肝在热、冷缺血状态下胆道微循环中可能存在的微血栓形成，进行前瞻性l艋床研究。以2006年1月至2007年3月实施并存活超过1年的肝脏移植病人112例为实验组；以1999年7月至2005年12月完成并存活超过1年的肝脏移植220例为对照组。实验组在供肝切取冷灌注时及供肝修整完毕后两次应用尿激酶灌洗供肝动脉系统。比较两组肝内缺血型胆道病变的发生率。结果对照组220例中13例受体术后发生肝内缺血型胆道病变，发生率5．9％，发生时间为术后3～11个月；实验组112例中2例分别在术后3、6个月发生肝内缺血型胆道病变，发生率1．8％。结论（1）无心跳尸体供肝存在较高的肝内胆道缺血型病变发生率和再移植率。（2）对无心跳尸体供肝常规采用尿激酶两次灌洗方案能有效降低肝内缺血型胆道病变的发生率。

Objective To discuss the approach of decreasing the incidence of intrahepatic ische- mic type biliary lesion in no-heart-beating donor to further reduce incidence of liver retransplantation. Methods Aiming at the possibility of microthrombosis into microcirculation of bile duct during warm and cold ischemia in no heart-beating donor, we conducted a prospective clinical study in 112 patients who underwent liver transplantation from January 2006 to March 2007 as the experimental group. Meanwhile, we retrospectively analyzed the data of 220 patients who also underwent liver transplanta- tion from July 1999 to December 2005 in our hospital as control group. We proposed to use urokinase perfusion artery system during graft harvesting and reperfusion at the end of graft trimming in experi- mental group. The incidence of intrahepatic ischemic biliary lesion in was compared between the 2 groups. Results All patients were followed up for over 12 months. The incidence of intrahepatic is- chemic biliary lesion was 5.9% （13/220） in the control group. On the contrary, its incidence was 1.8% （2/112） in the experimental group. Conclusion It has higher incidence of intrahepatic ischemic biliary lesion and retransplantation in no-heart beating donor. The incidence of intrahepatie ischemic biliary lesion can be reduced in no-heart-beating donor by using urokinase perfusion.