一种新型诊断和治疗肝移植术后缺血型胆道病变模式的研究

目的寻找一种用于诊断和治疗肝移植术后缺血型胆道病变（ITBLs）的新模式。方法选取2003年10月至2012年6月在中山大学附属第三医院肝脏移植中心行原位肝移植手术后确诊为ITBLs的80例受者。其中，传统模式组37例受者在出现ITBLs症状后接受药物治疗，明确诊断后行介入治疗和手术治疗，无效者行再次肝移植。早期诊断与干预模式（EDIM）组43例受者接受预防性药物治疗，定期行胆道超声造影，出现ITBLs征象时给予人脐带间充质干细胞移植，明确诊断后行介入治疗和手术治疗，无效者行再次肝移植。采用t检验比较两组受者初诊为ITBLs的时间、采取介入治疗的时间及移植肝丢失时间，采用Kaplan-Meier曲线和Log-Rank法比较两组移植肝1，3年生存率。结果传统模式组受者和EDIM组受者术后初诊为ITBLs的平均时间分别为（56±31）d和（24±19）d，两组比较差异有统计学差异（t=5．136，P〈0．05）。传统模式组和EDIM组从确诊为ITBLs到采取介入治疗的平均时间分别为（105±42）d和（58±20）d，两组比较差异有统计学差异（t=7．035，P〈0．05）。传统模式组和EDIM组死亡受者分别为8例和7例。传统模式组移植肝1，3年生存率分别89．2％，54．1％，EDIM组移植肝1，3年生存率分别95．3％，81．3％，传统模式组受者移植肝1，3年生存率均低于EDIM组（r=4．219，P〈0．05）。传统模式组和EDIM组移植肝丢失时间分别为（25±9）个月和（33±10）个月，传统模式组出现移植肝丢失时问早于EDIM组（t=-2．085，P=0．018）。结论早期诊断和干预ITBLs的新型模式可以延长术后移植肝存活时间，延迟移植肝丢失时间，提高ITBLs的整体治疗效果。

A study of new diagnostic and therapeutic modality for ischemic-type biliary lesions after liver transplantation

Objective To explore a new diagnostic and therapeutic modality for ischemic-type biliary lesions （ITBLs） and to improve the overall therapeutic effect of ITBLs. Methods Eighty liver transplantation patients diagnosed as ITBLs were included from October 2003 to June 2012. 37 cases were treated with traditional model which was used prior to February 2007. Briefly, Patients did not received drug treatment until symptoms of ITBLs appeared. After diagnosed, interventional treatment or surgery was performed. Retransplantation would be performed if all the above therapies were ineffective. Forty-three cases were treated with early diagnosis and intervention model （EDIM）. In this model, patients received preventive drug treatment and biliary contrast-enhanced ultrasound regularly. Humanumbilical cord mesenchymal stem cells transplantation would be performed if any symptom of ITBLs showed. After diagnosed, treatment protocols were similar as traditional model. The differences of time for diagnosis, treatment and occurrence of graft loss were determined by t test. Kaplan- Meier curve and Log-Rank test were applied to analyze the survival time of liver grafts. Results The time of ITBLs diagnosis was （56 ±31） days and （24 ± 19） days, respectively （t =5. 136, P 〈0.05）. The time between ITBLs diagnosis and an interventional therapy was （ 105 ± 42 ） days and （ 58 ± 20） days, respectively （t = 7.035, P 〈 0.05 ）. Eight and seven patients died in traditional model and EDIM group, respectively. In traditional model group, the 1-year and 3-year survival rate of liver grafts was higher （89.2% and 54.1% ）, compared with EDIM group （95.3% and 81.3% ）, shown a significant difference （X^2 =4. 219, P 〈 0.05 ）. The graft loss occurred at （25 ± 9） months and （33 ± 10） months after transplantation in traditional model and EDIM group （ t = - 2. 085, P 〈 0.05 ）, respectively. Conclusion The new EDIM has shown a better curative effect which could prolong the survival time of