减少肝移植术后胆道缺血性损伤的临床路径

Study of establishing a clinic procedure to reduce ischemic-type biliary lesions after liver transplantation

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.