活体肝移植供体及有或无肝硬变肝病患者右半肝切除术后预后的比较分析

目的探讨活体肝移植供体和肝病患者行右半肝切除术后的预后是否相似。方法纳入笔者所在医院肝脏移植中心2009～2010年期间的连续病例,包括40例不含肝中静脉的活体右半肝供体（活体肝移植供体组,简称LDLT-D组）及80例因肝病行右半肝切除的患者,其中40例为无肝硬变的肝病患者（无肝硬变肝病组,简称LD-NC组）及40例伴肝硬变的肝病患者（肝硬变肝病组,简称LD-WC组）。分析3组患者术前肝功能和一般临床资料,术中失血量和输血量,以及术后肝功能情况和并发症发生情况。结果 3组患者术前特征相似。LDLT-D组患者术中出血量较LD-NC组多〔（765±411）mL比（584±242）mL,P=0.008〕,与LD-WC组〔（666±224）mL〕接近（P=0.136）,但3组患者术中平均输血量相近（P=0.108）。术后第1天和第3天,LDLT-D组患者的TB和INR水平高于LD-NC组和LD-WC组（P〈0.05）,LD-WC组患者的ALT和AST水平均高于LDLT-D组和LD-NC组（P〈0.05）。LDLT-D组、LD-NC组及LD-WC组患者术后总并发症发生率分别是30.0%（12/40）、27.5%（11/40）和37.5%（15/40）,3组间的差异均无统计学意义（P=0.606）,但LD-WC组的ClavienⅢ级并发症发生率〔27.5%（11/40）〕高于LDLT-D组〔7.5%（3/40）〕及LD-NC组〔10.0%（4/40）〕,P=0.024。结论在右半肝切除术后早期阶段,活体肝移植供体肝功能损害更重;活体肝移植供体、无肝硬变的肝病患者和伴肝硬变的肝病患者术后总并发症发生率相近,但伴肝硬变肝病患者的严重并发症发生率高于活体肝移植供体及无肝硬变肝病患者。

Outcome Comparison of Right Hepatectomy among Living Liver Donation and Hepatic Patients with or Without Cirrhosis

Objective To approach whether the postoperative recovery processes of the living donors and hepatic patients after right hepatectomy is similar.Methods The clinical data of consecutive cases from 2009 to 2010 in our liver transplantation center was retrospectively analyzed,including 40 cases who donated the right lobe without the middle hepatic vein（living donor liver transpalntation-donor group,abbreviated as LDLT-D group）and 80 hepatic patients for right hepatectomy,in which 40 cases were hepatic patients without cirrhosis（liver disease-noncirrhosis group,abbreviated as LD-NC group）and 40 cases were hepatic patients with cirrhosis（liver disease-with cirrhosis group,abbreviated as LD-WC group）.Preoperative liver function and general clinical data,intraoperative blood loss and transfusion,postoperative liver function,and complications were statistically analyzed in this study.Results The preoperative parameters of three groups were comparable.LDLT-D group experienced more intraoperative bleeding than LD-NC group〔（765± 411）mL vs.（584±242）mL,P=0.008〕,and was similar to LD-WC group〔（666±224）mL,P=0.136〕.However,the average amount of blood transfusion products was similar among the 3 groups（P=0.108）.The levels of total bilirubin and INR of LDLT-D group were higher than LD-NC group and LD-WC group on the first and third day after operation（P 0.05）.The levels of ALT and AST of LD-WC group were higher than LDLT-D group and LD-NC group（P0.05）.The overall postoperative surgical morbidity incidence of LDLT-D group,LD-NC group,and LD-WC group were 30.0%（12/40）,27.5%（11/40）,and 37.5%（15/40）respectively,and were not statistically significant（P=0.606）.However,the Clavien Ⅲ complication rate of LD-WC group was higher than LDLT-D group and LD-NC group〔27.5%（11/40）vs.7.5%（3/40）and 10.0%（4/40）,P=0.024〕.Conclusions Liver function of living donors is injured more seriously during the early postoperative period.The total complication rates after right hepatectomy are similar among the living liver donation and hepatic patients with or without cirrhosis.However,the serious complication rate of cirrhotic liver recipients is higher than living donors and patients without cirrhosis.