胆道闭锁患儿活体肝移植和全肝移植术后早期肝功能的比较

摘要

目的比较胆道闭锁患儿活体肝移植和全肝移植术后早期肝功能变化。方法回顾性分析天津市第一中心医院2014年1月至6月胆道闭锁行小儿肝移植的患儿22例，其中行活体肝移植14例（活体组），行全肝移植8例（全肝组）。活体肝移植采用背驮式，左外叶供肝；全肝移植采用经典非转流术式。比较两组患儿肝移植术前、术中的临床资料，以及术后早期肝功能的变化。结果两组患儿性别、受体年龄、体重、术前Child-Pugh评分、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBil）、直接胆红素（DBil）水平以及术中失血量、输血量及移植物重量差异均无统计学意义（均P＞0.05）。与全肝组比较，活体组供者年龄更大〔（30.8±6.9）岁比（8.6±6.0）个月〕、手术时间更长〔（11.6±1.3）小时比（9.2±1.5）小时〕、冷缺血时间更短〔（72.1±21.7）分钟比（458.8±127.7）分钟〕，差异均有统计学意义（P＜0.05或P＜0.01）。术后早期随时间延长，两组患儿ALT、AST、TBil、DBil均显著降低（均P＜0.05）。术后1、2、3、4、5天活体组ALT水平（U/L：1294.0±1127.0、716.2±594.1、544.6±580.7、377.2±397.9、287.4±269.4）均高于全肝组（U/L：425.0±458.3、335.0±374.5、246.7±259.7、173.0±189.2、122.2±98.3），差异均有统计学意义（均P＜0.05）；术后6、7天活体组虽高于全肝组，但两组比较差异均无统计学意义（均P＞0.05）。两组术后各时间点AST水平比较差异均无统计学意义（均P＞0.05）。术后1～4天全肝组TBil和DBil均高于活体组，5～7天活体组高于全肝组，但两组各时间点比较差异均无统计学意义（均P＞0.05）。结论活体肝移植和全肝移植术后早期肝功能均恢复良好，而术后1～5天活体组ALT水平均高于全肝组，可能与活体肝移植手术时间过长及手术操作造成的肝组织缺血损伤有关。活体肝移植可以有效缓解供肝短缺的矛盾，缩短等待供肝的时间，值得推广。%Objective To compare the early graft function in biliary atresia patients after living donor liver transplantation and whole liver transplantation. Methods 22 children underwent pediatric liver transplantation for biliary atresia from January 2014 to June 2014 in Tianjin First Central Hospital. Among them,14 patients underwent living donor liver transplantation(LDLT group)using piggyback technique with left liver lobe,8 patients underwent whole liver transplantation without bypass(WLT group). Pre-operative and intraoperative clinical data and early postoperative liver function were compared retrospectively. Results There were no significant differences in age,gender,weight,preoperative Child-Pugh score,alanine aminotransferase(ALT), aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin(DBil),intraoperative blood loss,blood transfusion,and graft weight between these two groups(P>0.05). However,donor age was older in LDLT group〔(30.8±6.9)years vs.(8.6±6.0)months〕than that of WLT group,with longer operative time〔(11.6±1.3)hours vs.(9.2±1.5)hours〕and shorter cold ischemia time〔(72.1±21.7)minutes vs.(458.75±127.72)minutes〕(P<0.05 or P<0.01). Early after liver transplantation,ALT,AST,TBil,DBil decreased progressively(P<0.05). The ALT level of LDLT group(U/L:1 294±1 127,716.2±594.1,544.6±580.7,377.2±397.9,287.4±269.4) was significantly higher than that of WLT group(U/L:425.0±458.3,335.0±374.5,246.7±259.7,173.0±189.2, 122.2±98.31,P<0.05)on post operative day(POD)1,2,3,4,5,higher but without significant difference on POD 6 and 7(P>0.05). There was no statistical significance in AST level between two groups(P>0.05). The TBil and DBil levels of WLT group were higher on POD 1~4,but lower on POD 5~7 than that of LDLT group (P>0.05). Conclusion The liver function recovered well early after operation in both groups. ALT level of LDLT group was higher than that of WLT group on POD 1~5,which was probably related to longer operative time and ischemia injury caused by operation. LDLT is being advocated as an effective method to better meet the waiting-list needs and shorten the waiting time.