原位肝移植逆灌注法对术后肺部并发症的影响

Influence of retrograde reperfusion via vena cana on pulmonary complications after orthotopic liver transplantation

目的对比经典原位肝移植术和下腔静脉逆灌注肝移植术的围术期液体处理情况,并探讨两种手术方式对术后肺部并发症的影响。方法回顾性分析我院从2003年1月至2008年12月行肝移植手术的终末期肝病患者169例,根据手术方式的不同分为经典原位肝移植组（经典组）46例和下腔静脉逆灌注原位肝移植组（逆灌流组）123例。观察两组在不同Meld评分下两组患者肺部并发症的发生情况。分析比较两组患者围术期相关因素与术后肺部并发症情况的相关性。结果在Meld评分≤15分和15~25分的情况下,逆灌流组的肺部并发症显著低于经典组。逆灌流组和经典组相比,术中输液总量〉10L和输血液制品总量〉4L的患者明显减少（P=0.023和P=0.040）,术后前3d至少有2d的液体平衡≤-300ml的患者明显增多（P=0.048）。结论与标准经典原位肝移植术相比,下腔静脉逆灌注肝移植能够降低术后肺部并发症的发生率。

Objective To compare the pulmonary complications between the standard classic liver transplantation and classic liver transplantation with retrograde reperfusion via vena cana. Method One hundred and sixty-nine patients with end-stage liver disease underwent liver transplantation from January 2003 to December 2008 were retrospectively analyzed in our hospital. The patients were divided into standard classic liver transplantation group of 46 cases （group A） and retrograde reperfusion liver transplantation group of 123 cases （group B）, according to the operation way of liver transplantation. The rate of the pulmonary complication was observed in the two groups in different Meld scores. The perioperative factors of pulmonary complication were investigated. Results There were significant differences in pulmonary complication rate between the two groups in the situation of Meld score ≤15 points and 15-25 points. Compared with group A, patients with total intraoperative infusion10 L and the total blood products 4 L in group B obviously reduced（P = 0.023 and P = 0.040）. However, the patients whose negative fluid balance 300 ml in 2 days of the first 3 days after operation in group B obviously increased （P = 0.048）. Conclusion Compared with the standard classic liver transplantation, the classic liver transplantation with retrograde reperfusion via vena cana may significantly reduce the incidence of postoperative pulumonary complications.