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肝移植不同时期婴幼儿胆道闭锁活体肝移植的预后情况: 单中心101例经验分析
Prognos is of living donor liver transplantation performed during different periods in infants with biliary atresia: a single-center experience with 101 cases
文章发布日期:2013年11月28日  来源:  作者:华相伟,夏 强,张建军,等  点击次数:2462次  下载次数:443次

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【摘要】:目的对上海交通大学医学院附属仁济医院肝脏外科2010年前后婴幼儿胆道闭锁活体肝移植预后进行比较分析,旨在探讨不同时期手术的预后情况。方法回顾分析2006年10月至2012年12月间101例婴幼儿胆道闭锁活体肝移植病例资料。根据移植年份的不同将病例资料分为2006-2009年和2010-2012年2组,分析并比较2组术前一般资料、术中情况和预后情况。行Kaplan-Meier生存分析,计量资料的统计采用t检验,计数资料采用Fisher确切概率法和卡方检验。结果2组术前一般资料差异无统计学意义。2010-2012年组受者术中出血量(t=2.05, P=0.04)和供肝冷缺血时间(t=3.25, P<0.01)显著低于2006-2009年组。2010-2012年组受者术后胆道并发症(χ2=4.27,P=0.04),肺部感染并发症(χ2=4.47,P=0.03)和急性排斥反应(P=0.03)的发生率显著低于2006-2009年组。2010-2012年组受者术后生存情况明显好于2006-2009年组。2010-2012年组术后1、2年累积生存率分别为88.4%和88.4%,而2006-2009年组为84.4%和75%。结论外科技术和围手术期管理经验的积累,以及逐渐完善和规范的随访可提高手术成功率和术后生存率,并降低围手术期并发症的发生率。
【Abstract】:ObjectiveTo compared the prognosis between infants with biliary atresia (BA) who underwent living donor liver transplantation (LDLT) during 2006-2009 and 2010-2012 in the Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine and to evaluate the prognos is of LDLT performed during different periods. MethodsA retrospective analysis was performed on the clinical data of 101 infants with BA who underwent LDLT from October 2006 to December 2012. These patients were divided into 2006-2009 group and 2010-2012 group according to the year the procedure was performed. The two groups were compared in terms of preoperative general data, intraoperative status, and treatment outcome. The Kaplan-Meier method was used for survival analysis; measurement data were analyzed by t test, and enumeration data were analyzed by Fisher exact probability test and chi-square test. ResultsThe preoperative general data showed no significant difference between the two groups. Compared with the 2006-2009 group, the 2010-2012 group had significantly less intraoperative blood loss (t=2.05, P=0.04), a significantly shorter cold ischemia time of donor liver (t=3.25, P<0.01), and significantly lower incidence of postoperative biliary complications (χ2=4.27, P=0.04), pulmonary infection (χ2=4.47, P=0.03), and acute rejection (P=0.03). The 2010-2012 group had significantly improved survival compared with the 2006-2009 group; the 1 and 2 year cumulative survival rates for the 2010-2012 group were 884% and 88.4%, respectively, versus 84.4% and 75% for the 2006-2009 group. ConclusionThe development of surgical techniques, improvement in perioperative management, and standardized follow-up can significantly increase the success rate of surgery and survival rate and reduce postoperative complications in BA patients.
【关键字】:胆道闭锁;肝移植;婴儿;预后
【Key words】:biliary atresia; liver transplantation;infant; prognosis
【引证本文】:

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