背驮式与经典非转流式肝移植围术期临床疗效的研究

Analysis of the perioperative clinical efficacy of piggyback and classical non-bypass liver transplantation

目的通过回顾性对比分析采用背驮式和经典非转流式肝移植两种术式的患者的临床资料,比较两种术式对肝移植患者围术期并发症及病死率的影响。方法收集3家临床医疗中心于2005年6月至2013年6月间完成肝移植手术的患者资料。将患者分为背驮式肝移植组和经典非转流式肝移植组两组。采用t检验、秩和检验和卡方检验来比较两组患者之间各指标的差异;采用重复测量方差分析探究两组之间围术期肌酐浓度的差异;采用二元Logistics回归方法分析术后病死率的危险因素。结果共纳入1411例患者,其中背驮式肝移植组共纳入445例,经典非转流式肝移植组共966例。出院时死亡人数为54人,病死率为3.83%(54/1411);两组患者围术期的肌酐浓度变化趋势差异无统计学意义(F=2.63,P=0.11),但在不同时间点之间肌酐浓度有明显变化(F=25.86,P=0.00);采用二元Logistics回归整体分析两种术式在出院时转归(死亡或生存)上差异无统计学意义(OR=0.679,P=0.231),对3个中心进行亚组分析显示,中心3中采用两种术式的患者在出院时转归上差异有统计学意义(OR=0.213;P=0.04)。进一步对中心3的数据进行二元Logistics回归分析显示,术式、术后发生血滤、肺部感染及肾衰竭均为术后死亡的危险因素。结论经典非转流术式组与背驮式肝移植组患者术后肌酐浓度均明显高于术前;术式、术后血滤、肺部感染及肾衰竭为肝移植围术期死亡的独立危险因素。

Objective The clinical data of piggyback liver transplantation and classical non-bypass liver transplantation were analyzed retrospectively to compare the efficacy of the two methods on perioperative complications and case fatality rate of liver transplantation patients.Methods Liver transplantation patients from three clinical medical centers between June 2005 and June 2013 were divided into two groups:piggyback liver transplantation group and classical non-bypass liver transplantation group.T test,rank sum test and chi square test were used to compare the differences of observation indexes between the two groups,and repeated measurement analysis of variance was used to explore the difference of creatinine concentration between the two groups during perioperative period.Binary Logistics regression were used to analyze the risk factors of postoperative case fatality rate.Results A total of 1411 patients were recruied,including piggyback liver transplantation group(n=445)and classical non-bypass liver transplantation group(n=966).Totally 54 patients died at discharge,with a case fatality rate of 3.83%.The analysis of variance of repeated measurement showed that there was no significant difference in the change trend of creatinine concentration between the two groups during the perioperative period,but there was a significant change in creatinine concentration at different time points.The results of binary Logistics regression analysis showed that there was no significant difference in the states of discharge between the two operations(OR=0.679,P=0.231),the opposite result appeared in the subgroup analysis in the center 3(OR=0.213,P=0.004).Further analysis of the data of the center 3 by binary Logistics regression analysis showed that postoperative hemofiltration,pulmonary infection and renal failure were all risk factors of postoperative death.Conclusions The creatinine concentration after operation in both groups was significantly higher than that before operation.Postoperative hemofiltration,pulmonary infection and renal failure were independent risk factors for perioperative death of liver transplantation.