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目的分析和评价儿童活体和尸体肝移植的效果。方法回顾性分析320例终末期肝病儿童肝移植的预后及影响因素。根据肝移植手术方式的不同,将320例受者分为活体肝移植组(活体组)252例和尸体肝移植组(尸肝组)68例。活体组所有供者均为3代以内的直系亲属;尸肝组所有供者均为心脏死亡或脑死亡供者。比较两组受者术后存活情况和并发症情况。结果活体组受者1、2、3年的总体存活率分别为95.1%、93.5%和93.5%,尸肝组分别为92.3%、92.3%和82.4%,两组间比较差异无统计学意义(Log-rank χ~2=0.69,P=0.41)。随访期间,活体组死亡14例(5.56%),其中8例死于呼吸系统并发症,3例死于多器官功能衰竭,3例死于移植肝功能衰竭;尸肝组死亡5例(7.35%),其中1例死于呼吸系统并发症,2例死于多器官功能衰竭,1例死于腹腔出血,1例死于其他原因。两组门静脉血栓(PVT)、流出道梗阻、胆道并发症、肺部感染差异无统计学意义(均P>0.05),活体组肝动脉血栓(HAT)比例低于尸肝组(1.98%vs.10.29%,χ~2=10.245,P<0.01)。结论活体肝移植作为治疗终末期肝病的有效手段,疗效较好。
Objective To analyze and evaluate the effect of liver transplantation on live and dead children. Methods A retrospective analysis of 320 cases of end-stage liver disease in children with liver transplantation prognosis and influencing factors. According to the different methods of liver transplantation, 320 recipients were divided into 252 cases of living liver transplantation group (living group) and 68 cases of dead liver transplantation group (dead liver group). All donors in the living group were immediate relatives within 3 generations. All donors in the dead liver group were those with cardiac or brain death. Survival and complications of the two groups were compared. Results The overall survival rates at 1, 2, and 3 years in recipients were 95.1%, 93.5% and 93.5%, respectively, and 92.3%, 92.3% and 82.4% in the group of dead liver respectively. There was no significant difference between the two groups Log-rank χ ~ 2 = 0.69, P = 0.41). During the follow-up, 14 cases (5.56%) died of death in the living group, 8 of them died of respiratory complications, 3 died of multiple organ failure and 3 died of graft failure. In the dead liver group, 5 cases (7.35% ), Of which 1 died of respiratory complications, 2 died of multiple organ failure, 1 died of intraperitoneal hemorrhage and 1 died of other causes. No significant difference was found in PVT, biliary tract complications and pulmonary infection between the two groups (all P> 0.05). The proportion of hepatic arterial thrombosis (HAT) in the living group was lower than that in the dead liver group (1.98% vs. 10.29%, χ ~ 2 = 10.245, P <0.01). Conclusion Live liver transplantation as an effective treatment of end-stage liver disease, the effect is better.