不同热缺血时间的无心跳供肝在肝移植中应用的疗效评价-鞠卫强

18120091ChineseJournalofGeneralSurgeryVol.18　No.1Jan.　2009:(06104600)。:2008-10-08;　:2008-11-29。:,,,、。:　E-mail:[e-mail]　　:1005-6947(2009)01-0019-04··鞠卫强,何晓顺,韩明,邰强,巫林伟,马毅,王东平,朱晓峰,黄洁夫(中山大学附属第一医院器官移植中心,广州中山510080)　　:　。　14212h,3:Ⅰ5min,43;Ⅱ5～10min,77;Ⅲ10～15min,22。3(ALT)、、、、、。　3。ⅡALTⅠ;ⅢALT、、。8～32。Ⅲ,ⅠⅡ,。　12h10min;10min,,。[,2009,18(1):19-22]:;;;:R617　　　　:AEvaluationoftherapeuticeffectofvariedwarmischemiatimesofnon-heartbeatinglivergraftinlivertransplantationJUWeiqiang,HEXiaoshun,HANMing,TAIQiang,WULinwei,MAYi,WANGDongping,ZHUXiaofeng,HUANGJiefu(OrganTransplantationCenter,theFirstAffiliatedHospital,SunYat-SenUniversity,Guangzhou510080,China)Abstract:Objective　Toinvestigatethesafetyandtherapeuticeffectofdifferentwarmischemiatime(WIT)ofnon-heartbeating(NHBD)livergraftinclinicallivertransplantation.Methods　Aretrospectivestudyon142NHBDcaseswhichwereunderdifferentWITandcoldischemiatime(CIT)within12hwascarriedout.AccordingtodifferentWIT,thegraftsweredividedinto3groups:groupⅠ,lessthan5min(43cases);groupⅡ,5-10min(77cases);groupⅢ,10-15min(22cases).Thedifferencein3groupsintheaspectsofthepeakvalueofalanineaminotransferase(ALT),primarylivergraftnonfunction(PNF),acuterejection(AR),biliarycomplications,vascularcomplications,infection,graftsurvivalrateandrecipientsurvivalrateafterlivertransplantationwerecompared.Results　NoPNFoccurredin3groupspost-transplantationly.IngroupⅡonlythepeakvalueofASTandinfectionrateweresignificantlyhigherthangroupI;butthereweresignificantdifferencesbetweengroupⅢandgroupⅠintheaspectsofpeakvalueofAST,biliarycomplications,vascularcomplication,infectionrate.Thegraftsurvivalrateandrecipient中国普通外科杂志18survivalrateingroupⅢweresignificantlyshorterthangroupIandgroupⅡinfollowuptimewas8-23months.Conclusions　ForNHBDwithCITlessthan12h,themaximalsafedurationofWITis10minutes.IfWITisover10minutes,therewillbeasignificanthigherrateofcorrelativecomplications,lowergraftsurvivalrateandrecipientsurvivalrateafterlivertransplantation.[ChineseJournalofGeneralSurgery,2009,18(1):19-22]Keywords:LiverTransplantation;Non-Heart-BeatingDonor;WarmIschemia;ColdIschemiaCLCnumber:R617　　　　　　Documentcode:A　　(non-heart-beatingdonor,NHBD),、。142≤12h,。1　1.1　20061—200712178,142≤12h。142,115,27;30～65[(49.1±6.2)]。57,55(45),11,15,3,1。,。-,T。1.2　“”,,,4℃(HCA)2500～3000mL,4℃(UW)2000mL,5000mL。4℃HCA,500mL。。,4℃UW。1.3　12h,3～15min(15min)。3:Ⅰ5min,43;Ⅱ5～10min,77;Ⅲ10～15min,22。3(MELD),。1.4　:、、、。:(ALT)、(PNF)、、、、、。1.5　±(x±s)。t。()χ2。P0.05。2　　2.1　3、、(1)。1　3(x±s)Ⅰ(43)Ⅱ(77)Ⅲ(22)()26.7±4.827.1±4.327.5±3.9(h)9.1±2.38.9±1.88.5±1.9(min)425±33412±28430±38(min)35±639±837±6(mL)1105±5191165±4731296±4852.2　3PNF。ⅡALTⅠ,、、。ⅢALTI、ⅠⅡ(P0.05),ⅠⅡ(P0.05)(2)。201鞠卫强,等:不同热缺血时间的无心跳供肝在肝移植中应用的疗效评价2　3Ⅰ(43)Ⅱ(77)Ⅲ(22)PNF()000ALT(U/L,x±s)538±204876±3951)1217±6431)(%)11.6(5/43)13.0(10/77)13.6(3/22)(%)9.3(4/43)24.7(19/77)1)27.3(6/22)1)(%)7.0(3/43)2)10.4(8/77)2)31.8(7/22)(%)2.3(1/43)2)2.6(2/77)2)13.6(3/22)(%)86.0(37/43)2)87.0(67/77)2)63.6(14/22)(%)88.4(38/43)2)89.6(69/77)2)68.2(15/22)　　:1)Ⅰ,P0.05;2)Ⅲ,P0.053　　,NHBD。,5min;5min,UW8h,3min,12h,,[1]。,,。[2],30min,,(50.0±3.5)min。,。,NHBD,PNF,PNF[3-4]。,3142,1PNF。:NHBD,,,30～40min,。NHBD,。15min。,。ⅡALTⅠ,。12h10min,。ⅡⅢALTⅠ,,。,[5-6],。,。,。,。3。,,,[7-9]。ⅢⅠ,Ⅱ,Ⅰ,Ⅱ。12h,10min,。、,。,,。。,NHBD,,12h10min,10min,,。,,,。:[1]　.[M].:,1998:132-133.[2]　,,,.[J].,2003,83(14):1236-1240.[3]　BrokelmanW,StelAL,PloegRJ,etal.Riskfactorforpri-marydysfunctionafterlivertransplantationintheUniversityofWisconsinsolutionera[J].TransplantProc,1999,31(5):2087-2090.[4]　BricenoJ,MarchalT,PadilloJ,etal.Influenceofmarginaldonorsonliverpreservationinjury[J].Transplantation,2002,74(4):522-526.[5]　PirenneJ,GunsonB,KhaleefH,etal.Influenceofische-mia-reperfusioninjuryonrejectionafterlivertransplantation21中国普通外科杂志18[J].TransplantProc,1997,29(1-2):366-367.[6]　MalufDG,StravitzRT,CotterellAH,etal.Adultlivingdo-norversusdecreaseddonorlivertransplantation:a6-yearssinglecenterexperience[J].AmJTransplant,2005,5(1):149-156.[7]　,,,.[J].,2006,15(7):493-496.[8]　Kupiec-WeglinskiJW,BusuttiRW.Ischemiaandreperfu-sioninjuryinlivertransplantation[J].TransplantProc,2005,37(4):1653-1656.[9]　NakamuraN,NishidaS,NeffGR,etal.Intrahepaticbiliarystrictureswithouthepaticarterythrombosisafterlivertransplan-tation:ananalysisof1113livertransplantationsatasinglecenter[J].Transplantation,2005,79(4):427-432.　　:2008-07-30。　　:,,,。　　:　E-mail:[e-mail]　　:1005-6947(2009)01-0022-01··1吴国聪(首都医科大学附属北京友谊医院普通外科,北京100050):;;:R656.5　　　　:D　　　,49。3。B,。CT,,,,,。。,、6cm×5cm×4cm,,,,。:。:1,5cm×4.2cm×2.6cm。,;:,、、、,(1)。:1　,、、、,　,,,“;”(1989-2008),4[1-2]。[3],,,5、,、。6,[4]。,[5]。,。、、。B、CT,。,、、[6]。。,,。,。16,,,。[1]　,,,.3[J].,2005,43(22):1476-1477.[2]　.1[J].,2008,15(1):26.[3]　.[A].:,X、CT、MRI[M].:,2000:460-473.[4]　SumiyoshiK,ShimizuS,EnjojiM,etal.Bronchogeniccystintheabdo-men[J].VirchowsArchAPatholAnatHistopathol,1985,408(1):93-98.[5]　InguA,WatanabeA,IchimiyaY,etal.Retroperitonealbronchogeniccyst:acasereport[J].Chest.2002,121(4):1357-1359.[6]　AnderssonR,LindellG,CwikielW,etal.Retroperitonealbronchogeniccystasadifferentialdiagnosisofpancreaticmucinouscys