活体供者供肝术后早期并发症分析

The early postoperative complications in living liver transplantation donors

目的探讨活体肝移植供者术后早期并发症的发生情况。方法对2002年1月至2009年8月间170例活体肝移植供者的临床资料进行回顾性分析，依据供肝类型分为右半供肝组和左半供肝组，采用Clavien分类系统对术后早期发生的并发症进行分析。结果两组间供者年龄、身高体重指数、手术时间等差异均无统计学意义（P〉0．05）。与左半供肝组比较，右半供肝组实际切取的供肝重量较大（P〈0．05），残余肝重量较小（P〈0．05），残余肝重量与标准肝重量之比较小（P〈0．05），且住院时间较长（P〈0．05）。住院期间，共有55例供者发生并发症62例次，总的并发症发生率为32．35％（55／170），其中右半供肝组并发症发生率为34．39％（54／157），左半供肝组并发症发生率为7．69％（1／13），两组比较，差异无统计学意义（x^2=2．787，P〉O．05）。62例次并发症中，I级39例次，Ⅱ级5例次，Ⅲ级16例次占，Ⅳa级2例次，无Ⅳb和V级（死亡）并发症。所有并发症经积极治疗后得以痊愈，所有供者均健康存活。结论活体肝移植供者总体安全性较好，但仍面临着发生严重并发症的风险。术前应严格对供者进行选择和评估，术中手术操作应严密精细，重视供者术后管理，避免供者术后发生并发症。

Objective To investigate the incidence of early postoperative complications in living donor liver transplantation. Methods Postoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors （right-lobe graft, R group and left-lobe graft, L group）. Early postoperative complications were analyzed using Clavien classification system. Results The difference between two groups was no statistically significant in donor＇ s age, body mass index, operation time and other characters （P^0. 05）. R group had a bigger actual cut weight of donor liver （P〈0. 05）, smaller residual liver weight （P〈0. 05） which also smaller than standard liver weight （P〈0. 05）, and a longer hospital stay （P〈0. 05） than L group. During hospitalization, 62 complications occurred in 55 cases with the total complication rate being 32.35% （55/170）. In detail, the incidence of complications was 34. 39% （54/157） in R group, and 7. 69% （1/13） in L group （chi-square value = 2. 787, P〉0. 05）. Among these 62 complications, there were 39 times of Ⅰ grade, 5 times of Ⅱ grade, 16 times of Ⅲ grade, 2 times of IV a grade. All the complications were cured by active treatment and all donors survived well. Conclusion Although the security of living donor liver transplantation is better, the risk of serious complications must be faced. We must strictly select and assess the donor before the operation, very carefully carry out surgical operation, and pay more attention to postoperative management in order to avoid postoperative complications of donors.