本文選題：肝移植 + 血管架橋　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:旨在對比肝移植術(shù)中行肝動脈或門脈搭橋術(shù)與未行搭橋術(shù)的患者術(shù)后并發(fā)癥(主要是血管并發(fā)癥及膽道并發(fā)癥)、肝功能恢復(fù)情況及生存率之間的差異。方法:選取浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院2011年11月至2016年9月行肝移植術(shù)并于術(shù)中行血管架橋的患者(共計(jì)12例,其中動脈架橋7例,靜脈架橋4例,動靜脈均架橋1例)作為實(shí)驗(yàn)組,并選取浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院2011年11月至2016年9月行肝移植術(shù)但未行血管架橋,且保證供肝與受體門脈主干端端吻合,受體吻合動脈比例與實(shí)驗(yàn)組一致者(共計(jì)33例)作為對照組。動脈、靜脈搭橋組與對照組術(shù)前男女比例、年齡、是否腫瘤、血型是否相合、術(shù)前肝功能情況(包括谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、總膽紅素(TB)、白蛋白(Alb)、凝血酶原時(shí)間(PT)、Child-Pugh評分、MELD評分(小兒用PELD評分)等)、冷缺血時(shí)間、熱缺血時(shí)間、無肝期、膽道吻合方式均無明顯差異(p0.05)。由此分別對比兩組術(shù)后血管并發(fā)癥、膽道并發(fā)癥情況,術(shù)后1天、3天、5天、7天及大于1月的肝動脈及門脈血流情況,術(shù)后1天、2天、3天、7天及大于1月的肝功能情況及術(shù)后至記錄數(shù)據(jù)當(dāng)天患者的生存情況。生存資料分析及曲線繪制采用Kaplan-Meier方法,余計(jì)數(shù)資料應(yīng)用卡方檢驗(yàn),計(jì)量資料應(yīng)用獨(dú)立樣本t檢驗(yàn)。結(jié)果:術(shù)后分別比較動靜脈搭橋組與未搭橋組肝功能情況,在術(shù)后1天、2天、3天、7天及大于1月的時(shí)間范圍里,兩組患者ALT、AST、TB、Alb、PT均無明顯差異(p0.05);對比動脈搭橋組與未搭橋組術(shù)后1天、3天、5天、7天及大于1月的左、右肝動脈阻力指數(shù)(RI)及血流峰值,得到在術(shù)后第1天動脈搭橋組左右肝動脈RI顯著大于對照組(p0.05),在術(shù)后第7天左右肝動脈RI均顯著小于對照組(p0.05),而兩組在肝動脈峰值流速的比較中無顯著性差異(p≥0.05);對比靜脈搭橋組與未搭橋組術(shù)后1天、3天、5天、7天及大于1月的門靜脈血流峰值,得到術(shù)后1天時(shí)架橋組門靜脈右支峰值流速及術(shù)后5天門靜脈左支峰值流速顯著小于對照組(p0.05),而其余時(shí)間兩組的門靜脈峰值流速無顯著性差異(p0.05)。對比術(shù)后并發(fā)癥情況,動脈架橋組與靜脈架橋組術(shù)后至記錄數(shù)據(jù)當(dāng)日膽道并發(fā)癥發(fā)生人數(shù)與未發(fā)生人數(shù)比例為2:5和0:4,與未搭橋組(膽道并發(fā)癥發(fā)生人數(shù)與未發(fā)生人數(shù)比例為4:29)無顯著性差異(p0.05)。動脈架橋組與靜脈架橋組術(shù)后至記錄數(shù)據(jù)當(dāng)日血管并發(fā)癥發(fā)生人數(shù)與未發(fā)生人數(shù)比例為1:6和1:3,與未搭橋組(血管并發(fā)癥發(fā)生人數(shù)與未發(fā)生人數(shù)比例為1:32)無顯著性差異(p0.05);對比術(shù)后兩組患者生存情況,動脈架橋組與靜脈架橋組術(shù)后至記錄數(shù)據(jù)當(dāng)日生存情況與未搭橋組無明顯差異(p0.05)。結(jié)論:在各種原因肝血管無法進(jìn)行端端吻合的肝移植手術(shù)中,血管搭橋可作為一個(gè)安全且有效的替代吻合方式,因其并不增加術(shù)后膽道并發(fā)癥及血管并發(fā)癥的發(fā)生,并不影響遠(yuǎn)期肝功能的恢復(fù),對患者的術(shù)后生存率無明顯影響。
[Abstract]:Objective: to compare the postoperative complications (mainly vascular complications and biliary complications), liver function recovery and survival rate between patients undergoing hepatic artery or portal bypass grafting and those without bypass grafting. Methods: from November 2011 to September 2016, the first affiliated Hospital of Zhejiang University Medical College was selected from 12 patients (including 7 cases of arterial bridge and 4 cases of venous bridge) who underwent liver transplantation and vascular bridge during operation. The first affiliated Hospital of Zhejiang University School of Medicine received liver transplantation from November 2011 to September 2016, but no vascular graft was performed, and the donor liver was anastomosed with the main portal vein of the recipient. The proportion of recipient anastomosis artery was the same as that in experimental group (33 cases) as control group. The ratio of male and female, age, tumor and blood type match between the artery and vein bypass group and the control group before operation. Preoperative liver function (including alanine aminotransferase (alt), aspartate aminotransferase (AST), total bilirubin (TBN), Albn, prothrombin time (PTT), Child-Pugh score (PELD score in children), cold ischemia time, hot ischemia time, anhepatic phase, etc. There was no significant difference in anastomosis of bile duct (P 0.05). The blood flow of hepatic artery and portal vein were compared between the two groups on 1 day, 3 days, 5 days, 7 days and more than 1 month, respectively, and the blood flow of hepatic artery and portal vein were compared between the two groups. The liver function was more than 1 month after operation and the survival status of the patients was recorded from the first day to the end of the day. Survival data analysis and curve drawing were analyzed by Kaplan-Meier method, chi-square test was used for residual count data, and independent sample t-test was used for measurement data. Results: the liver function of the arteriovenous bypass group was compared with that of the non-bypass group, and the liver function was more than 1 month after operation in the period of 1 day, 2 days, 3 days, 7 days, and more than 1 month, respectively. There was no significant difference between the two groups (P 0.05), and there was no significant difference between the two groups (P < 0.05), and compared the left and right hepatic artery resistance index (RI) and the peak value of blood flow between the artery bypass graft group and the non-bypass graft group on the 1st day, the 3rd day, the 5th day and 7 days after the operation, and the left and right hepatic artery resistance index (RI) were larger than that in the first month. The RI of right and left hepatic artery in the graft group was significantly higher than that in the control group on the 1st day after operation, and the RI of the hepatic artery was significantly lower than that of the control group on the 7th day after operation, but there was no significant difference between the two groups in the peak velocity of hepatic artery. The peak value of portal vein blood flow in the venous bypass group was compared with that in the venous bypass graft group and that in the non-bypass group and the venous bypass graft group respectively on 1 day, 3 days, 5 days, 7 days, and more than 1 month, respectively. The peak velocities of the right portal vein and the left portal vein in the bridging group were significantly lower than those in the control group on the 1st day after operation, but there was no significant difference between the two groups in the other time. Comparing the postoperative complications, There was no significant difference in the number of biliary complications between the arterial bridging group and the venous bridge group from 2:5 to 0: 4 between the two groups (the ratio of the number of biliary complications to none was 4: 29), and there was no significant difference between the two groups (p 0.05). The ratio of the number of vascular complications to non-occurrence was 1:6 and 1: 3 in the arterial bridging group and the vein bridging group, but there was no significant difference between the artery bridging group and the non-bypass graft group (the ratio of the number of vascular complications to the number of non-occurrence was 1: 32). The survival status of the two groups was compared. There was no significant difference between the arterial bridging group and the venous bridging group from the same day to the same day as the non-bypass group (P 0.05). Conclusion: vascular bypass graft can be used as a safe and effective alternative anastomosis in liver transplantation for various reasons, because it does not increase the incidence of postoperative biliary complications and vascular complications. The recovery of long-term liver function was not affected, and the postoperative survival rate was not significantly affected.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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