儿童终末期肝病模型评分用于预测婴幼儿活体肝移植预后的作用

Value of pediatric end-stage liver disease score in predicting prognosis after pediatric living donor liver transplantation

目的探讨儿童终末期肝病模型(PELD)评分系统用于预测婴幼儿活体肝移植预后的作用。方法回顾性分析2006年10月至2012年12月上海交通大学医学院附属仁济医院肝脏外科收治的101例小儿活体肝移植临床资料。患儿术前诊断均为胆道闭锁。术前对每例患儿进行PELD评分,根据PELD评分将患儿分为两组:低分组(PELD评分<16分,62例)和高分组(PELD评分≥16分,39例)。比较两组患儿围手术期的基本情况及术后并发症发生率。结果两组患儿的手术年龄和体重差异均有统计学意义(均为P<0.05),但两组性别、移植物(肝)重量/受体的体重、供肝冷缺血时间、术中失血量等差异均无统计学意义(均为P>0.05)。PELD高分组患儿移植术后的肺部感染和胆道并发症发生率均明显高于低分组(均为P<0.05)。结论术前PELD评分可用于预测婴幼儿肝移植的预后,为婴幼儿肝移植的围手术期的治疗、监护及护理措施的制定提供参考。对于术前PELD评分较高的患儿,应加强围手术期并发症的监护处理。

Objective To explore the value of pediatric end-stage liver disease （PELD）score system in predicting prognosis after pediatric living donor liver transplantation （LDLT）. Methods Clinical data of 101 infants undergoing living-donor liver transplantation from October 2006 to December 2012 in Department of Liver Surgery in Affiliated Renji Hospital of School of Medicine of Shanghai Jiaotong University,were analyzed retrospectively. All infants were diagnosed as biliary atresia. PELD scores before LDLT were graded. According to PELD scores,all the patients were divided into two groups：low score group （PELD score 〈16,n=62） and high score group （PELD≥16,n =39 ）.The basic data during perioperative period and incidence of postoperative complications were compared between two groups. Results There were significant differences in age and body weight between two groups （both in P〈0.05 ）. But there was no significant difference between the two groups in gender,graft to recipient weight ratio （GRWR）,cold isehemia time and intraoperative blood loss （all in P〉0.05 ）. The incidence of lung infection and biliary complications in high score group were significantly higher than those in low score group. Conclusions Preoperative PELD score can be used in predicting prognosis after pediatric LDLT and provide a reference for the treatment,caring and nursing during perioperative period of pediatric LDLT. For infants with high PELD score before operation,the care of perioperative complications should be enhanced.