不同时期婴幼儿胆道闭锁活体肝移植的预后情况:单中心101例经验分析

Prognos is of living donor liver transplantation performed during different periods in infants with biliary atresia: a single- center experience with 101 cases

目的对上海交通大学医学院附属仁济医院肝脏外科2010年前后婴幼儿胆道闭锁活体肝移植预后进行比较分析,旨在探讨不同时期手术的预后情况。方法回顾分析2006年10月至2012年12月间101例婴幼儿胆道闭锁活体肝移植病例资料。根据移植年份的不同将病例资料分为2006-2009年和2010-2012年2组,分析并比较2组术前一般资料、术中情况和预后情况。行Kaplan-Meier生存分析,计量资料的统计采用t检验,计数资料采用Fisher确切概率法和卡方检验。结果 2组术前一般资料差异无统计学意义。2010-2012年组受者术中出血量(t=2.05,P=0.04)和供肝冷缺血时间(t=3.25,P<0.01)显著低于2006-2009年组。2010-2012年组受者术后胆道并发症(χ2=4.27,P=0.04),肺部感染并发症(χ2=4.47,P=0.03)和急性排斥反应(P=0.03)的发生率显著低于2006-2009年组。2010-2012年组受者术后生存情况明显好于2006-2009年组。2010-2012年组术后1、2年累积生存率分别为88.4%和88.4%,而2006-2009年组为84.4%和75%。结论外科技术和围手术期管理经验的积累,以及逐渐完善和规范的随访可提高手术成功率和术后生存率,并降低围手术期并发症的发生率。

Objective To compared the prognosis between infants with biliary atresia （BA） who underwent living donor liver transplantation （ LD- LT） during 2006 -2009 and 2010 -2012 in the Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine and to evaluate the prognos is of LDLT performed during different periods. Methods A retrospective analysis was performed on the clinical data of 101 infants with BA who underwent LDLT from October 2006 to December 2012. These patients were divided into 2006 - 2009 group and 2010 - 2012 group according to the year the procedure was performed. The two groups were compared in terms of preoperative general data, intraoperative sta- tus, and treatment outcome. The Kaplan - Meier method was used for survival analysis ; measurement data were analyzed by t test, and enumeration data were analyzed by Fisher exact probability test and chi -square test. Results The preoperative general data showed no significant difference between the two groups. Compared with the 2006 -21309 group, the 2010 -2012 group had significantly less intraoperative blood loss （t =2. 05, P =0.04）, a significantly shorter cold ischenfia time of donor liver （t = 3. 25, P 〈 0. 01 ）, and significantly lower incidence of postoperative biliary complications （X2 = 4. 27, P = 0. 04）, pulmonary infection （X2 = 4. 47, P = 0.03 ）, and acute rejection （ P = 0.03 ）. The 2010 - 2012 group had significantly improved survival compared with the 2006 -2009 group; the 1 and 2 year cumulative survival rates for the 2010 -2012 group were 88. 4% and 88.4%, respectively, versus 84.4% and 75% for the 2006 -2009 group. Conclusion The development of surgical techniques, im- provement in perioperative management, and standardized follow - up can significantly increase the success rate of surgery and survival rate and reduce postoperative complications in BA patients.