肝移植术后胆道并发症的Clavien分级及高危因素分析

Analysis of high risk factors and classification for biliary tract complication following liver transplantation

目的探讨肝移植术后胆道并发症（biliarycomplication，BC）发生高危因素及Clavien分级在BC分类中的意义。方法逐步回归法筛选BC发生的高危因素；对BC进行Clavien分级，筛选Clavienl]Ib级以上BC发生的高危因素。结果14．4％（26／181）的肝移植患者发生BC，其中ClavienⅢb级以上BC占84．6％（22／26）。BC组的回归分析表明：T管留置（P=0．0090，OR=31．177），术后1d肝动脉阻力指数（Rlld）（P=0．0094，OR〈0．001），术后1周肝动脉阻力指数（R11w）（P=0．0013，OR〉999．999）的差异有统计学意义，且对该疾病的发生作用显著。ClavienllIb以上BC组的回归分析表明：RIJd（P=0．0065，OR〈0．001）、R11w（P=0．0022，OR〉999．999）的差异有统计学意义，且对该疾病的发生作用显著。结论Clavien分级系统对胆道并发症的分类具有重要指导意义。T管的放置增加了BC发生的风险，但并不会增加ClavienⅢb以上BC的发生。术后肝动脉血流异常的存在是BC尤其是ClavienⅢb以上Bc发生的独立危险因素。

Objective To retrospectively study the high risk factors for hiliary complication （BC） and the application of the Clavien system to classify BC in a large cohorts of subjects undergoing liver transplantations （LT）. Methods The clinical data of 181 patients who received LT from Jan. 2004 to Dec. 2008 were studied. BC was classified using the Clavien system. The risk factors of hiliary complication were evaluated by using a binary forward stepwise logistic regression analysis. Results 14.4%（26/181） recipien＊s developed BC （BC group）. In 84.6%（22/26） patients the BC was above the Clavien HI b. Regression analysis of BC revealed that the placement of a T tube （P= 0. 0090, OR 31.177）, Rlld （P=0.0094, OR〈0.001）, RIlw （P=0.0013, OR〉999. 999） were significant ly associated with the development of BC. Regression analysis of BC above Clavien Ⅲ b revealed that Rlld （P=0. 0065, OR〈0. 001, Rllw （P=0. 0022, OR〉999. 999） were significantly associated with the development of BC above Clavien Ⅲb. Conclusions The Clavien classification system was useful to classify BC. The placement of a T tube was an independent risk factor to predict BC, it was not a factor for BC above Clavien Ⅲb. Hepatic arterial insufficiency （HAD was an independent risk factor for BC and BC above Clavien Ⅲb.