本文選題：肝移植 + 夜間手術�。� 參考：《浙江大學》2016年碩士論文

【摘要】：背景：肝臟移植手術作為終末期肝病的唯一最佳治療方式,發(fā)展至今從操作技術到術后管理都已經有了豐富的經驗和長足的進步。但是各種術后并發(fā)癥也一直伴隨著肝移植術的存在。腎臟移植具有較長的冷缺血時間窗口期,提供了將夜間移植推遲到次日的可能性。肝臟移植手術又與之不同,可以不影響預后的冷缺血時間窗口期很短。若是夜間進行肝臟移植手術與白天手術相比并不會增加術后并發(fā)癥的發(fā)生,證明我們現(xiàn)在采取的措施足夠安全,更支持我們盡量縮短供肝缺血時間,以實現(xiàn)更好的預后結果。方法：本研究通過回顧性的將在浙江大學醫(yī)學院附屬第一醫(yī)院進行肝臟移植手術的患者838例,根據(jù)其手術時間在白天或是夜間分為兩組,通過分析兩組間的術后并發(fā)癥是否存在顯著性差異,并通過多因素logistic回歸模型找出造成其差異的原因,從而明確夜間進行肝移植手術的風險,并根據(jù)單中心的實際經驗總結,為肝移植手術安全性提供更好的支持。結果：根據(jù)手術進腹時間與關腹時間求得的手術中位時間點定義該次手術時間,9am-9pm為白天手術組,反之是夜間手術組。兩組基本信息進行比較年齡、性別、基礎疾病、Child-Pugh評分上沒有差異(P0.05), MELD評分白天組稍高于夜間組,而缺血時間在夜間組長于白天組。Kaplan-Meier方法分析結果提示夜間手術組與白天手術組的術后總體生存并沒有顯著性差異。夜間手術組術后全隨訪期間的膽道并發(fā)癥、血管并發(fā)癥、PNF的數(shù)量較白天組并沒有顯著性差異。在移植物失功的發(fā)生上夜間組高于白天組(P=0.033),但經過logistic回歸模型分析發(fā)現(xiàn)手術時間分組被平衡,得到冷缺血時間是影響術后移植物失功的獨立風險因素。結論：基于單中心的研究,在夜間進行肝臟移植手術對比在白天手術并不影響長期生存。同時,無論長期還是短期隨訪結果,夜間手術對膽道并發(fā)癥、血管并發(fā)癥、切口并發(fā)癥等均不增加其發(fā)生風險。移植物失功在夜間手術組發(fā)生率更高,但是.這是由冷缺血時間導致而與夜間手術本身無關。繼續(xù)展開多中心的研究可以比較各中心對夜間手術的安排管理,進一步明確改善移植手術預后的管理方法。
[Abstract]:Background: liver transplantation is the only best treatment for end-stage liver disease. However, various postoperative complications have been accompanied by liver transplantation. Kidney transplantation has a long cold ischemic window, providing the possibility of delaying the night transplant to the next day. Unlike liver transplantation, cold ischemic window period is very short without affecting prognosis. If liver transplantation at night does not increase the incidence of postoperative complications compared with daytime surgery, it proves that the measures we take now are safe enough and support us to shorten the time of donor liver ischemia as far as possible to achieve a better prognosis. Methods: a total of 838 patients undergoing liver transplantation in the first affiliated Hospital of Zhejiang University Medical College were divided into two groups according to the time of operation during the day or at night. By analyzing whether there were significant differences in postoperative complications between the two groups, and finding out the causes of the differences by using multivariate logistic regression model, the risk of liver transplantation at night was determined, and the actual experience of single center was summarized. To provide better support for the safety of liver transplantation. Results: according to the median time of operation, 9am-9pm was defined as the daytime operation group and the night operation group as the nocturnal operation group. There was no difference in age, sex and Child-Pugh score between the two groups (P0.05). Meld score in daytime group was slightly higher than that in night group. The results of Kaplan-Meier method showed that there was no significant difference in overall survival between the nocturnal operation group and the daytime operation group. There was no significant difference in the number of vascular complications and PNF between the night operation group and the daytime group. The incidence of graft dysfunction in the night group was higher than that in the daytime group (P0. 033), but the logistic regression model showed that the operative time group was balanced, and the cold ischemia time was an independent risk factor for postoperative graft failure. Conclusion: based on a single-center study, liver transplantation at night does not affect long-term survival compared with daytime surgery. At the same time, the risk of biliary complications, vascular complications and incision complications was not increased by night operation, regardless of the long term or short term follow-up results. The incidence of graft dysfunction was higher in the nocturnal operation group, however. This is due to cold ischemic time and not to the nocturnal operation itself. The multi-center study can be used to compare the management of night operation in different centers and to improve the prognosis of transplantation.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R657.3

【參考文獻】

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1 Alberto Ferrarese;Alberto Zanetto;Martina Gambato;Ilaria Bortoluzzi;Elena Nadal;Giacomo Germani;Marco Senzolo;Patrizia Burra;Francesco Paolo Russo;;Liver transplantation for viral hepatitis in 2015[J];World Journal of Gastroenterology;2016年04期

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本文編號：2103527