活体右半肝移植术后供体残肝血流动力学变化的临床研究

Clinical Research on the Post-operative Hemodynamics Changes in Donors after Living Donor Liver Transplantation

目的通过对53例活体右半肝肝移植供体术后的长期随访,探讨供体术后血流动力学变化及相关影响因素。方法纳入2010年12月至2015年8月间行活体右半肝肝移植术的供体共53例,术后通过彩色多普勒超声定期测定供体残肝血流动力学,瞬时弹性扫描仪检测其肝脏硬度,分析供体术后残肝功能、肝脏血流动力学、肝实质硬度、脾脏等长期生存指标的变化趋势。结果供体术后1周内,主要表现为一过性肝功能损害;血流动力学随术后时间呈现以下趋势:门静脉管径呈逐渐增加、流速呈逐渐降低趋势;肝静脉管径呈逐渐增加、流速呈逐渐降低趋势;门静脉管径与门静脉流速呈负相关关系(P=0.012,r=-3.11);肝脏硬度(Kpa值)随时间逐渐降低;而脾脏厚度逐渐增加。相关分析显示肝脏硬度与门静脉管径呈负相关(P=0.013,r=-0.338)、与肝静脉流速呈正相关(P=0.038,r=0.246)。结论供体在术后会出现一过性肝功能损伤表现并于1周内趋于正常;血流动力学不影响供体术后的长期安全性。

Objective To investigate the postoperative hemodynamics changes and their influence factors in the donors after right lobe living donor liver transplantation. Methods A total of 53 consecutive living donors from Dec 2010 to Aug 2015 who underwent donor right lobe hepatectomy were retrospectively analyzed. We measured residual liver hemodynamics with color doppler ultrasound, detected liver stiffness by transient elastography, also analyzed postoperative liver function, hemodynamics, and the long term variation tendency of hepatocirrhosis and spleen. Results One week after operation, transient liver damage was observed. Post-operative hemodynamics within the follow-up time showed：portal vein diameter was gradually increasing, the velocity decreased gradually;Hepatic vein diameter increased, and the velocity decreased gradually. There was a negative correlation between portal vein diameter and portal vein velocity （P=0.012, r=-3.11）. Liver stiffness （Kpa value） decreased gradually with time, while spleen volume gradually increased. Correlation analysis showed that postoperative liver stiffness （Kpa value） was negatively related to portal vein diameter （P=0.013, r=-0.338） and positively related to hepatic venous velocity （P=0.038,r=0.246）. Conclusion The donor presented a transient liver injury after operation, but tended to be recovery after one week. Despite post-operative hemodynamic undergo a series of changes, but it does not affect the post-operative long-term donor safety.