天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 806-809.doi: 10.11958/20160273

• 专题研究·胆道闭锁与肝移植 • 上一篇    下一篇

儿童活体和尸体肝移植的临床效果比较

祖彩华 ， 滕大洪 ， 李俊杰 ， 高伟 ， 郭庆军 ， 马楠 ， 蔡金贞 ， 沈中阳 ， 张国梁   

  1. 1 天津医科大学一中心临床学院（邮编 300192）；2天津市第一中心医院器官移植中心， 3 消化科
  • 收稿日期:2016-04-08 修回日期:2016-05-03 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 张国梁 E-mail:caihuazu@163.com
  • 作者简介:祖彩华（1989）， 女， 硕士在读， 主要从事消化系疾病的研究

Comparison of clinical effects between pediatric living donor liver transplantation and deceased donor liver transplantation

ZU Caihua, TENG Dahong, LI Junjie, GAO Wei, GUO Qingjun, MA Nan, CAI Jinzhen，SHEN Zhongyang, ZHANG Guoliang   

  1. 1 First Central Clinical College, Tianjin Medical University, Tianjin 300192, China; 2 Organ Transplant Center, 3 Department of Gastroenterology, Tianjin First Central Hospital
  • Received:2016-04-08 Revised:2016-05-03 Published:2016-07-15 Online:2016-07-15
  • Contact: ZHANG Guoliang E-mail:caihuazu@163.com

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摘要： 目的 分析和评价儿童活体和尸体肝移植的效果。 方法 回顾性分析 320 例终末期肝病儿童肝移植的预后及影响因素。 根据肝移植手术方式的不同， 将 320 例受者分为活体肝移植组（活体组）252 例和尸体肝移植组（尸肝组）68 例。 活体组所有供者均为 3 代以内的直系亲属； 尸肝组所有供者均为心脏死亡或脑死亡供者。 比较两 组受者术后存活情况和并发症情况。 结果 活体组受者 1、2、3 年的总体存活率分别为 95.1%、93.5%和 93.5%， 尸肝组分别为 92.3%、92.3%和 82.4%， 两组间比较差异无统计学意义（Log-rank χ2=0.69， P=0.41）。 随访期间， 活体组死亡14 例（5.56%）， 其中 8 例死于呼吸系统并发症， 3 例死于多器官功能衰竭， 3 例死于移植肝功能衰竭； 尸肝组死亡 5 例（7.35%）， 其中 1 例死于呼吸系统并发症， 2 例死于多器官功能衰竭， 1 例死于腹腔出血， 1 例死于其他原因。 两组门静脉血栓（PVT）、流出道梗阻、胆道并发症、肺部感染差异无统计学意义（均 P＞ 0.05）， 活体组肝动脉血栓（HAT）比例低于尸肝组（1.98% vs. 10.29%， χ2=10.245， P < 0.01）。 结论 活体肝移植作为治疗终末期肝病的有效手段， 疗效较好。

关键词: 肝移植, 活体供者, 肝, 尸体, 儿童

Abstract: To analyze and evaluate the efficacy of living donor liver transplantation (LDLT) and deceaseddonor liver transplantation (DDLT). Methods The clinical data of prognosis and influencing factors of 320 children with liver transplantation were analyzed retrospectively. The 320 children were divided into LDLT group (n=252) and DDLT group (n=68) based on their operation styles. In LDLT group, all donors to recipients were immediate relatives within three generation. In DDLT group, all livers were obtained from cardiac death or brain death donors. The survival and incidence of complications were observed between two groups. Results The 1-year, 2-year and 3-year cumulative survival rates for recipients were 95.1%, 93.5% and 93.5% in LDLT group, and 92.3%, 92.3% and 82.4% in LDLT group. There was no significant difference between the two groups (Log- rank χ2=0.69， P=0.41). During the follow- up period,14 cases died (5.56%) in LDLT group, in which 8 deaths due to respiratory complication, 3 deaths due to multiple organ failure, and 3 deaths due to graft failure. In DDLT donor group, 5 cases died (7.35%), in which 1 death due to respiratory complication, 2 deaths due to multiple organ failure, 1 death due to intra-abdominal hemorrhage, and 1 case of unknown cause of death. There were no significant differences in portal vein thrombosis (PVT), outflow tract obstruction, biliary tract complications and pulmonary infection between the two groups (P > 0.05). The ratio of hepatic artery thrombosis (HAT) was lower in LDLT group than that of DDLT group (1.98% vs. 10.29%， χ2=10.245， P < 0.01). Conclusion Living donor liver transplantation is an effective method to treat end-stage liver disease

Key words: liver transplantation, living donors, liver, cadaver, child