劈离式肝移植中供肝IV段门静脉重建对受者术后早期肝功能恢复的应用价值初探

Preliminary Study on Application Value of Segment IV Portal Vein Reconstruction in Split Liver Transplantation for Early Postoperative Recovery of Liver Function

摘要: 目的：探讨在劈离式肝移植中供肝IV段门脉重建对术后早期肝功能恢复的意义。方法：回顾性分析2015年1月1日至2019年12月31日青岛大学附属医院器官移植中心16例劈离式肝移植右三叶受者的临床资料，按照是否进行IV段肝门脉重建分为两组，其中未进行门脉重建组(对照组) 4例，进行门脉重建组(重建组) 12例。观察两组受者术前、术后第1、3、7、14、30天丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase, AST)、碱性磷酸酶(alkaline phosphatase, ALP)、γ-谷氨酰转肽酶(gamma-glutamyltransferase, GGT)、总胆红素(total bilirubin, TB)、直接胆红素(direct bilirubin, DB)、乳酸(lactic acid, lac)水平。使用R语言统计软件进行数据处理，正态分布计量资料以均值 ± 标准差表示，对独立样本采用t检验比较重建组与对照组。计数资料采用卡方检验进行比较。对P值小于0.05的数据认为具有统计学差异。结果：在受者观察指标中，两组受者术后第1天ALT、AST、ALP、lac，术后第3天ALT、ALP，术后7天ALT、lac，术后14天ALT、TB、DB差异存在统计学意义(P < 0.05)，其余结果差异均无统计学意义(P > 0.05) 结论：供肝IV段门静脉重建对术后2周内肝功能恢复具有积极作用，应用供肝IV段门静脉重建技术有利于术后早期肝功能恢复。统计学上未发现供肝IV段门静脉重建对肝移植术后2周后肝功能恢复情况存在明显影响。

Abstract: Objective: To explore the clinical value of segment IV portal vein reconstruction in split liver transplantation for early postoperative recovery of liver function. Methods: A retrospective analysis of 16 recipients with split liver transplantation from the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from January 1st, 2015 to December 31st, 2019 was conducted. Two groups were divided according to whether IV portal vein reconstruction was performed. No portal vein reconstruction was performed in 4 patients (control group). Portal vein reconstruction was performed in 12 patients (reconstruction group). Alanine Aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), Total bilirubin (TB), Direct bilirubin (DB), lactic acid (lac) levels were observed before surgery, 1 day after surgery, 3 days after surgery, 7 days after surgery, 14 days after surgery, and 30 days after surgery. Statistical software in R language was used for data processing. Normal distribution measurement data were expressed as mean ± standard deviation, and independent samples were compared between reconstruction group and control group by T-test. Non-normal distribution measurement data are represented by the median. Data with P value less than 0.05 were considered to have statistical difference. Results: Among the observed indicators of recipients, ALT, AST, ALP, lac of the two groups on the first day after surgery, ALT, ALP of the third day after surgery, ALT, lac of the seventh day after surgery, and ALT, TB, DB of the fourteenth day after surgery showed statistically significant differences (P < 0.05), while the other results showed no statistically significant differences (P > 0.05). Conclusions: IV portal vein reconstruction of the donor liver has a positive effect on the recovery of liver function within 2 weeks after the operation. The application of IV portal vein reconstruction of the donor liver is beneficial to the early recovery of liver function after the operation. There was no statistically significant effect of donor IV portal vein reconstruction on the recovery of liver function 2 weeks after liver transplantation.