摘要
目的:针对肝移植术后并发症缺血性胆道损伤(ITBL),试图建立区分各种导致ITBL的危险因素的临床路径,降低ITBL的发生率。方法:记录随访335例行原位肝移植术(OLT)病例的可能导致胆道缺血的危险因素,包括供肝热缺血时间、冷缺血时间、温缺血时间及供肝脂肪肝情况等。按照冷缺血时间分两组I:TBL组和正常组。比较其他危险因素在两组间的差别。结果:冷缺血时间控制〈8 h,正常组81例,ITBL组2例,热缺血时间差别有统计学意义(P=0.017);8~12 h,正常组150例I,TBL组25例,胆道温缺血时间差异有统计意义(P=0.033);〉12 h,正常组57例I,TBL组20例,供肝脂肪肝发生率差异有统计学意义(P〈0.05)。结论:为避免ITBL,冷缺血时间〈8 hI,TBL的发生率很低,只要控制好热缺血时间即可;冷缺血时间8~12 h,尽量将胆道温缺血时间控制在1 h左右;冷缺血时间〉12 h,对于有严重脂肪变的边缘供体可以考虑弃用。
Objecitve: Ischemic-type biliary lesions(ITBL) are hard to be controlled after orthotopic liver transplantation(OLT).A clinic procedure should be established to distinguish risk factors.Method: 335 cases of patients who undergo OLT in this study are divided into 2 groups: ITBL group and normal group.Record risk factors including Warm ischemia time(WIT),Cold ischemia time(CIT),Temperate ischemia time(TIT),steatosis of donor liver etc.These risk factors are compared between the 2 groups separately within three different CIT time intervals.Result: WIT is found statistically different within 8h of the CIT time interval(P=0.017);TIT statistically different within 8~12h of the CIT time interval(P=0.033);the incidence of steatosis liver of a graft different within the time interval over 12h(P0.05).Conclusion: A clinic procedure is established that when a graft's CIT can be controlled within 8h,the ITBL may have low chance to occur in a recipient;when a graft's CIT is within 8~12h in clinic,TIT should be controlled in about 1hour in the operation close behind;when it is can be predicted that a graft's CIT will be over 12h due to a long journey of transport,a graft with obvious steatosis should be given up.
出处
《中国现代普通外科进展》
CAS
2011年第7期531-534,576,共5页
Chinese Journal of Current Advances in General Surgery
关键词
胆道缺血性损伤
危险因素
冷缺血时间
热缺血时间
肝移植
Ischemic-type biliary lesion·Risk factor·Cold ischemia time·Warm ischemia time·Orthotopic liver transplantation