供肝获取和灌洗方式对移植术后早期肝功能的影响

目的 探讨不同的供肝获取和灌洗方式对移植术后早期肝功能的影响.方法 对442例肝移植的临床资料进行回顾性分析.442例均为尸体供者,供肝切取术中采用腹主动脉和脾静脉插管对供肝进行原位灌洗,灌洗液为4℃UW液或4℃UW液联合高渗枸橼酸盐嘌呤溶液(HC-A液),获取的供肝均保存于UW液中.按照供肝获取方式、灌洗液的种类、灌洗液静脉引流途径及胆道冲洗方法的不同将病例分为5组.肝移植术后1周,测定受者血清总胆红素(TBil)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(γ-GT)及前白蛋白(PA)等肝功能指标,以及活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白(Fb)及国际标准化比值(INR)等凝血功能指标.结果 肝、肾分别切取者的供肝获取手术耗时(17.6±2.5)min,联合切取者为(15.9±2.3)min,二者间的差异有统计学意义(P＜0.05).联合切取者中,灌洗液经颈静脉引流者的γ-GT、AST、PT和INR明显低于经肝下下腔静脉引流者(前一项P＜0.01,后三项P＜0.05),而Fb明显高于经肝下下腔静脉引流者(P＜0.05);采用UW液和HC-A液联合灌洗者,其γ-GT、ALT、AST,DB和TT均明显低于单用UW液灌洗者(前三项P＜0.05,后二项P＜0.01),而Fb明显高于单用UW液灌洗者(P＜0.01).结论 联合切取法有利于缩短器官获取时问;采用UW液和HC-A液联合灌洗及灌洗液经颈静脉引流更有利于术后早期肝功能的恢复.

Effects of different methods of liver graft harvesting and perfusion on early liver function after transplantation

Objective To compare the effects of different methods of liver graft harvesting and perfusion on early liver function after transplantation.Methods The clinical data of 442 cases of cadavefic liver transplantation was retrospectively analyzed.The techniques for graft harvesting included in situ perfusion through abdominal aorta and splenic vein.UW solution and hypertonic citrate adeniBe solution(HCA)at 4℃ were used for organ perfusion and preservation. All cases were divided into 5 groups according to different methods of harvesting,perfusion,drainage through vena cava and irrigation of biliary tract.The liver function and blood coagulation were observed by groups one week after liver transplantation.Results There were significant differences betwin the time of separate and combined harvesting(P＜0.05).There were no significant differences in all indexes between the above two methods,as well as perfusion of UW solution and combined HCA solution(P>0.05).There were significant differences in aspartate aminotransferase(AST),prothrombin time (PT),international normalized ratio (INR) and fibrinogen (Fb) between groups by drainage through jugular vein and inferior vena cava(P＜0.05).There was significant difference in γ-glutamyl transpeptidase(γ-GT)between groups by irrigation through gallbladder and combined choledochus(P＜0.01).There were significant differences in γ-GT,alanine aminotransferase (ALT),AST,direct bilirubin(DB),Fb and thrombin time(TT)between groups by the improved method of combined harvesting and the original method(P＜0.05).Conclusion It iS suggested that the modified techniques of combined rapid harvesting and perfusion are simple,efficient and safe to improve the utilization and the quality of cadaveric organs,and the recovery of liver function after transplantation.