活体肝移植术后胆道并发症的研究及相关因素的分析

目的 分析活体肝移植（LDLT）术后的胆道并发症（BC）及相关因素。方法 回顾性分析瑞金医院肝移植中心2006年6月至2009年9月实施的42例LDLT的临床资料，对LDLT术后BC的发生进行总结和分析。统计LDLT术后BC发生的可能因素，进行单因素对照分析。结果 42例LDLT其中出现BC 16例（A组），未出现BC 26例（B组），BC的发生率为38.1%。A组与B组LDLT患者在右半肝和左半肝所占比例（50% vs 9.1%）（P=0.044）、有无动脉并发症所占比例（70% vs 28.1%）（P=0.045）、冷缺血时间（cold ischemic time，CIT）（P=0.048）、无肝期时间（P=0.037）、移植物受者体重比（graft weight/recipient weight，GWRW）（P=0.04）及GRWR≥1（P=0.029）等6个因素上比较差异有统计学意义。结论 LDLT术后BC的发生率高低与手术医生的熟练程度，手术方法的改进，缩短冷缺血时间、无肝期时间有关，还与左右半肝比例和GWRW有关。

Analysis of the factors of biliary complication afte living donor liver transplantation

Objective To analyze the biliary complication (BC) after living donor liver transplantation (LDLT)and its related factors. Methods Retrospective analysis was done in 42 patients who received LDLT between Jun. 2006 and Sep. 2009 in Ruijin Liver Transplantation Center. Possible factors involving in BC after LDLT were summarized and analyzed. Results Of all the 42 patients who received LDLT, 16 of them suffered from BC (Group A), while the other 26 didn't (Group B), so the occurrence rate of BC was 38.1%. Comparing Group A and B, there were statistically significant differences in 6 factors: ①the proportion of receiving right or left liver transplantation in the 42 patients (50% vs 9.1%, P=0.044); ②whether there was artery complication or not (70% vs 28.1%, P=0.045); ③cold ischemic time (CIT, P=0.048); ④anhepatic period (P=0.037); ⑤graft weight/recipient weight(GWRW, P=0.04); ⑥GRWR≥1 (P=0.029). Conclusion The occurrence rate of BC after LDLT is related to the proficiency of surgeons, the advancement of skills, shortening time of CIT and anhepatic period, the proportion of receiving right or left liver and the GWRW.