不同时期肝移植术后胆道并发症发生率差异及相关因素分析

Analysis of morbidities and related factors for biliary complication following liver transplantation in different periods

目的分析不同时期实施的肝移植术后发生胆道并发症(biliary complication,BC)的发生率及其相关因素。方法将不同时期所做的181例肝移植患者分为A组(早期肝移植病例,2004年1月至2005年12月)95例,B组(近期肝移植病例,2006年1月至2008年12月)86例。统计两组肝移植患者的BC发生率,并对两组中与BC发生可能有关的因素进行单因素对照分析。结果181例肝移植中发生BC26例(14.4%);A组BC发生率为21%(20/95),B组BC发生率为7%(6/86),两组的BC发生率比较差异有统计学意义(P<0.05)。A组与B组肝移植患者在新的胆管缝合方式(含前后间断缝合,后壁连续、前壁间断改良缝合)所占比例(6%比23%)、冷缺血时间(cold ischemic time,CIT)、二次热缺血时间、手术时间、术中输血率(76%比62%),术后2周门静脉平均流速(PVMV)6个因素上比较差异有统计学意义。结论近期肝移植术后BC发生率低于早期肝移植,这与近期手术熟练程度提高和手术方法改进,从而缩短手术时间、二次热缺血时间有关。

Objective To explore the differences in morbidities and the related factors of BC following liver transplantation （LT） in different periods.Methods The clinical data of 181 patients receiving LT from Jan.2004 to Dec.2008 were collected completely.All cases were divided into group A （earlier period,from Jan.2004 to Dec.2005） and group B （later period,from Jan.2006 to Dec.2008）.The differences in morbidities of BC at different periods were analyzed and the related factors were compared by using a univariate statistic analysis.Results Twenty-six （14.4%） recipients developed BC,20 out of 95 patients receiving LT in group A （21%） and 6 out of 86 patients receiving LT in group B （7%）.There was significant difference in BC morbidities between these two groups （P 0.05）.Univariate analysis between group A and group B showed related factors associated with BC including the proportion of new biliary reconstruction techniques application （6% compare to 23%）,cold ischemic time,second warm ischemic time,operative time,intraoperative blood transfusion rate （76% compare to 62%） as well as portal vein mean velocity （PVMV） in 2 weeks after operation.Conclusion Patients underwent LT in later period has lower morbidity of BC compared with earlier period.Proficiency and improvements in operative techniques can reduce BC incidence by shortening operative time and second warm ischemic time.