机器人辅助腔镜肝胆胰脾手术并发症144例分析

目的:分析机器人辅助腔镜肝胆胰脾手术术后并发症的类型及影响因素,为手术开展提供参考。方法:2014年11月至2017年12月,机器人辅助腔镜肝胆胰脾手术144例资料和随访结果,分析并发症发生的影响因素。结果:144例患者中男69例,女75例,发生近期并发症40例,远期并发症20例。单因素分析显示,手术部位、术前有无合并症对术后近期并发症的发生率有着重要影响(P<0.05)。多因素分析示,无论近期并发症或是远期并发症,胰腺手术并发症发生率高于其他部位的手术。胰腺手术的近期并发症以胰瘘和出血为主,远期并发症以胰腺断端的包裹性积液为主。结论:胰腺疾病的患者行机器人辅助腔镜手术易发生术后近期及远期并发症,但其远期并发症多无较大危险性。

Pediatric liver transplantation in 31 consecutive children

Background Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements. Methods Thirty-one children （≤18 years old） underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old （ranged from 5 months to 18 years） with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson＇s disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard （without venovenous bypass）, 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug （FK506, steroid, and mycophenolate mofetil） immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months. Results Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus （HBV） or hepatitis C virus （HCV） infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively. Conclusions The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients＇ age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.

肝移植围术期EPO应用的效果及安全性研究

目的评价重组人促红细胞生成素在肝移植围术期中的效果及安全性。方法回顾分析我院2015年9月~2016年12月原位肝移植89例患者的化验检查、用药情况及围术期输血情况,排除二次肝移植手术患者、死亡患者、术中输血>50 U患者,根据围术期是否应用r Hu EPO,分为EPO组和对照组。EPO组入院后根据围术期贫血情况皮下注射r Hu EPO 10000 U/次,1次/d或1次/2 d;对照组入院后未用r Hu EPO。观察两组患者术后血红蛋白、红细胞计数、网织红细胞计数以及输血量的对比情况。结果 (1)EPO组患者经治疗后,术后3 d(T_1)、术后7 d(T_2)、术后15 d(T_3)及术后1个月(T_4)与术前基础值(T0)比较,Hb变化不大,差异无统计学意义(P>0.05);对照组Hb T_1、T_2、T_3、T_4与T0比较明显降低,差异有统计学意义(P<0.01);EPO组T0时点Hb明显低于对照组,差异有统计学意义(P<0.01),在T_3、T_4时点Hb高于对照组,差异有统计学意义(P<0.05)。(2)EPO组患者经治疗后,T_1、T_2、T_3、T_4与T0比较,RBC计数差异无统计学意义(P>0.05);对照组RBC T_1、T_2、T_3、T_4与T0比较降低,差异有统计学意义(P<0.05);对照组T_1、T_2、T_3、T_4时点RBC低于EPO组,差异有统计学意义(P<0.05)。(3)EPO组患者经治疗后,网织红细胞计数(RET)T_3、T_4时点较对照组明显上升,差异有统计学意义(P<0.01);EPO组T_3、T_4时点与T0比较,RET升高,差异有统计学意义(P<0.01);对照组RET在T_1、T_2、T_3、T_4与T0比较差异无统计学意义(P>0.05);组间比较,EPO组T_3、T_4时点RET明显高于对照组,差异有统计学意义(P<0.01)。结论肝移植贫血患者在围术期皮下注射r Hu EPO,术后1个月患者的贫血改善好于对照组,提示r Hu EPO对肝移植贫血的重症患者安全、有效。