保留供肝胃十二指肠动脉对肝移植术后胆道并发症的影响

Effect of preserving gastroduodenal artery of liver graft on biliary complications after liver transplantation

目的探讨保留供肝胃十二指肠动脉的改良供肝修剪方法对肝移植受者术后胆道并发症的影响。方法回顾性分析2011年9月至2019年11月在佛山市第一人民医院行原位肝移植的129例受者临床资料。其中男120例,女9例;年龄31~71岁,中位年龄50岁。受者均签署知情同意书,符合医学伦理学规定。根据供肝修剪方法,将受者分为改良组(56例)和常规组(73例)。改良组技术要点是保留胃十二指肠动脉远端至少2 cm,特别注意保留胰十二指肠上动脉后支以及变异的肝右动脉,以保证胆总管远端血供。观察两组肝移植围手术期情况。两组手术时间比较采用t检验,术后住院时间比较采用Mann-Whitney U检验,术后胆道并发症发生率比较采用χ^(2)检验。结果改良组平均手术时间为(7.4±1.2)h,明显少于常规组的(8.0±1.3)h(t=-2.524,P<0.05)。改良组术后住院时间分别为16(14)d,明显少于常规组的22(11)d(Z=2.970,P<0.05)。改良组术后胆道并发症发生率为5%(3/56),明显低于常规组的21%(15/73)(χ^(2)=6.091,P<0.05)。结论保留供肝胃十二指肠动脉的改良修肝方法可保持胰十二指肠上后动脉及周围组织的完整性,有利于保护肝外胆管的血供,降低肝外胆管缺血所导致的肝移植术后胆道并发症发生率。

Objective To evaluate the effect of modified liver graft repairing method,preserving the gastroduodenal artery of graft on the biliary complications after liver transplantation.Methods Clinical data of 129 recipients undergoing orthotopic liver transplantation in the First People's Hospital of Foshan from September 2011 to November 2019 were retrospectively analyzed.Among them,120 patients were male and 9 female,aged from 31 to 71 years,with a median age of 50 years.The informed consents of all recipients were obtained and the local ethical committee approval was received.According to different liver graft repairing methods,all recipients were divided into the modified group(n=56)and conventional group(n=73).In the modified group,at least 2 cm of the distal end of gastroduodenal artery was reserved,especially the posterior branch of superior pancreaticoduodenal artery and the variant right hepatic artery,to guarantee the distal blood supply of common bile duct.Perioperative conditions of the recipients were observed in two groups.The operation time between two groups was compared by t test.The length of postoperative hospital stay was compared by Mann-Whitney U test.The incidence of postoperative biliary complications was compared by Chi-square test.Results The average operation time in the modified group was(7.4±1.2)h,significantly shorter than(8.0±1.3)h in the conventional group(t=-2.524,P<0.05).The length of postoperative hospital stay in the modified group was 16(14)d,significantly shorter than 22(11)d in the conventional group(Z=2.970,P<0.05).The incidence of postoperative biliary complications in the modified group was 5%(3/56),significantly lower than 21%(15/73)in the conventional group(χ^(2)=6.091,P<0.05).Conclusions The modified liver graft repairing method with reserved gastroduodenal artery can maintain the integrity of the superior posterior pancreaticoduodenal artery and its surrounding tissues,which is beneficial to protect the blood supply of extrahepatic bile duct and reduce the incidence of biliary complications caused by extrahepatic bile duct ischemia after liver transplantation.