自体门静脉血冲洗供肝在原位肝移植中的应用价值

Application value of donor liver autologous portal venous blood rinse in orthotopic liver trans-plantation

目的探讨自体门静脉血冲洗供肝在原位肝移植中的应用价值。方法采用回顾性队列研究方法。收集2018年5月至2019年6月中国科学技术大学附属第一医院收治的35对行原位肝移植供者和受者的临床病理资料;35例供者,男31例,女4例;年龄为(48±9)岁;35例受者,男25例,女10例;年龄为(47±9)岁。35例受者中,16例采用自体门静脉血冲洗供肝,设为门静脉组;19例采用白蛋白冲洗供肝,设为白蛋白组。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用Fisher确切概率法。结果(1)手术情况。门静脉组和白蛋白组受者无肝期时间、开放后5 min内动脉血Ca2+浓度分别为(52±12)min、(0.99±0.10)mmol/L和(64±12)min、(1.05±0.07)mmol/L,两组上述指标比较,差异均有统计学意义(t=2.94,2.22,P<0.05);开放后5 min内平均动脉压、开放后5 min内动脉血K+浓度、开放后5 min内动脉血pH值分别为(70±24)mmHg(1 mmHg=0.133 kPa)、(4.7±1.3)mmol/L、7.27±0.06和(71±28)mmHg、(4.6±1.1)mmol/L、7.30±0.07,两组上述指标比较,差异均无统计学意义(t=0.14,0.30,1.22,P>0.05)。(2)术后情况。门静脉组和白蛋白组受者发生再灌注后综合征、严重再灌注后综合征(心脏停搏)、原发性移植物无功能分别为6、0、2例和8、1、1例,两组上述指标比较,差异均无统计学意义(P>0.05);术后第7天总胆红素分别为(90±52)μmol/L和(166±112)μmol/L,两组比较,差异有统计学意义(t=2.66,P<0.05);术后第7天国际标准化比值、术后7 d内丙氨酸转氨酶最高值、术后7 d内天冬氨酸转氨酶最高值分别为2.1±2.0、(1952±2813)IU/L、(3944±6673)IU/L和1.8±0.6、(1023±1014)IU/L、(2005±2910)IU/L,两组上述指标比较,差异均无统计学意义(t=0.66,1.23,1.08,P>0.05)。门静脉组和白蛋白组受者发生肝动脉并发症、胆道并发症分别为1、2例和0、4例,两组上述指标比较,差异均无统计学意义(P>0.05)。门静脉组和白蛋白组受者围手术期分别死亡3例和2例。(3)随访情况。35例受者中,30例获得术后随访,随访时间为534(28~776)d。随访期间,门静脉组受者中,3例发生术后并发症,其中2例死亡,1例经对症治疗后恢复良好。白蛋白组受者中,5例发生术后并发症,其中1例死亡,4例经对症治疗后恢复良好。截至随访日期,门静脉组11例受者和白蛋白组16例受者均恢复良好。结论肝移植术中应用自体门静脉血冲洗供肝可以缩短无肝期时间,不增加再灌注后综合征、缺血再灌注损伤和胆道并发症的发生。

Objective To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation(OLT).Methods The retrospective cohort study was conducted.The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected.Of the 35 donors,there were 31 males and 4 females,aged(48±9)years.Of the 35 recipients,there were 25 males and 10 females,aged(47±9)years.Of the 35 recipients,16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group,and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Measurement data with normal distribution were represented as Mean±SD,and compari-son between groups was analyzed using the t test.Measurement data of skewed distribution were represented as M(range).Count data were descried as absolute numbers,and comparison between groups was analyzed using the Fisher exact probability.Results(1)Surgical situations.The anhepatic phase time and arterial blood Ca2+concentration within 5 minutes after reperfusion of the recipients were(52±12)minutes and(0.99±0.10)mmol/L in the portal vein group,versus(64±12)minutes and(1.05±0.07)mmol/L in the albumin group,showing significant differences in the above indicators between the two groups(t=2.94,2.22,P<0.05).The mean arterial pressure,arterial blood K+concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were(70±24)mmHg(1 mmHg=0.133 kPa),(4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group,versus(71±28)mmHg,(4.6±1.1)mmol/L and 7.30±0.07 in the albumin group,showing no significant difference in the above indicators between the two groups(t=0.14,0.30,1.22,P>0.05).(2)Post-operative situations.Cases with post-reperfusion syndrome(PRS),cases with severe PRS of cardiac arrest,cases with primary graft nonfunction of the recipients were 6,0,2 in the portal vein group,versus 8,1,1 in the albumin group,showing no significant difference in the above indicators between the two groups(P>0.05).Total bilirubin on postoperative day 7 of the recipients was(90±52)μmol/L in the portal vein group,versus(166±112)μmol/L in the albumin group,showing a significant difference between the two groups(t=2.66,P<0.05).International normalized ratio on postoperative day 7,the highest alanine aminotransferase and aspartate aminotransferase within 7 days after operation of the recipients were 2.1±2.0,(1952±2813)IU/L and(3944±6673)IU/L in the portal vein group,versus 1.8±0.6,(1023±1014)IU/L and(2005±2910)IU/L in the albumin group,showing no significant difference in the above indicators between the two groups(t=0.66,1.23,1.08,P>0.05).Recipients with hepatic artery complication and biliary complication were 1 and 2 in the portal vein group,versus 0 and 4 in the albumin group,showing no significant difference in the above indicators between the two groups(P>0.05).There were 3 cases and 2 cases died during the perioperative period in the portal vein group and the albumin group,respectively.(3)Follow-up.Of the 35 recipients,30 recipients were followed up for 534(range,28‒776)days after operation.During the follow-up,there were 3 patients with postoperative complications in the portal vein group including 2 cases died and 1 case recovered after sympto-matic treatment.There were 5 patients with postoperative complications in the albumin group including 1 case died and 4 cases recovered after symptomatic treatment.Up to the follow-up date,11 patients in the portal vein group and 16 patients in the albumin group were in good condition.Conclusion Rinse of the donor liver with autologous portal venous blood during liver transplantation can shorten the time of anhepatic phase,without increasing the occurrence of post-reperfusion syndrome,ischemia re-perfusion injury and biliary tract complications.