Analysis of risk factors for non-anastomotic biliary stricture following liver transplantation
-
摘要:
目的探讨肝移植术后非吻合口胆道狭窄(NABS)的危险因素。方法回顾性分析2004年1月-2010年12月年肝移植病例175例,对早期(2004年1月-2006年12月)93例与后期(2007年1月-2010年12月)82例的2组患者发生NABS的危险因素(性别、年龄、原发疾病、血型、是否保留T管、急性排斥反应、胆道感染、巨细胞病毒感染、Child-Pugh评分、冷缺血时间、热缺血时间、无肝期时间和术后1周平均肝动脉血流)进行分析,每组按照是否发生NABS再分为2个亚组(发生组和未发生组)。采用单因素及多因素Logistic回归分析两组患者发生NABS的危险因素。结果单因素分析显示早期非吻合口胆道狭窄的危险因素包括:是否发生胆道感染、是否留置T管和是否发生急性排斥反应;在后期,是否发生急性排斥反应对NABS发生的影响有统计学意义。Logistic回归分析结果显示在早期是否发生急性排斥反应对NABS发生有统计学意义(P=0.014)。结论早期肝移植导致NABS的危险因素通过围手术期的治疗干预,可以规避胆道感染和留置T管,降低NABS的发生。而后期急性排斥反应发生率虽然降低,但其对NABS的...
Abstract:Objective To investigate the risk factors for non-anastomotic biliary stricture (NABS) following liver transplantation.Methods A retrospective analysis was performed on 175 patients who underwent liver transplantation from January 2004 to December 2010 to analyze the risk factors for NABS, which included sex, age, primary disease, blood type, T-tube placement, acute rejection, biliary tract infection, cytomegalovirus infection, Child-Pugh score, cold ischemia time, warm ischemia time, duration of anhepatic phase, and mean hepatic artery blood flow within one week after operation.These patients were divided into early group, who underwent operation from January 2004 to December 2006, and late group, who underwent operation from January 2007 to December 2010;each group was further divided into two subgroups according to whether they developed NABS.The risk factors for NABS were determined by univariate and multivariate logistic regression analyses.Results The univariate logistic regression analysis showed that the risk factors for NABS were biliary tract infection, T-tube placement, and acute rejection in the early group (P<0.05) and that acute rejection was the risk factor in the late group (P=0.003) .The multivariate logistic regression analysis showed that acute rejection was significantly associated with NABS in the early group (P=0.014) .Conclusion The risk factors for NABS following liver transplantation from January 2004 to December 2006;biliary tract infection and T-tube placement could be prevented by perioperative interventions, thus reducing the incidence of NABS.The incidence of acute rejection was reduced from January 2007 to December 2010, but it was still significantly associated with NABS.
-
Key words:
- liver transplantation /
- non-anastomotic biliary stricture /
- risk factors
-
[1]Patkowski W, Nyckowski P, Zieniewicz K, et al.Biliary tract com-plications following liver transplantation[J].Transplant Proc, 2003, 35 (2) :2316-2317. [2]Desphande RR, Rela M, Girland R, et al.Long-term outcome ofliver retransplantation in children[J].Transplantation, 2002, 74 (8) :1124-1130. [3]Scatton O, Meunier B, Cherqui D, et al.Randomized trial of choledo-choledochostomy with or without a T tube in orthotopic liver transplanta-tion[J].Ann Surg, 2001, 233 (3) :432-437. [4]Vallera RA, Cotton PB, Clavien PA.Biliary reconstruction for livertransplantation and management of biliary complications:overviewand survey of current practices in the United States[J].LiverTranspl Surg, 1995, 1 (3) :143-152. [5]Steinhoff G, Behrend M, Schrader B, et al.Intercellular immuneadhesion molecules in human liver transplants:overview on expres-sion patterns of leukocyte receptor and ligand molecules[J].Hepa-tology, 1993, 18 (2) :440-453. [6]Zhang RL, Lu LG.Current research on the biliary tract diseases[J].J Clin Hepatol, 2011, 27 (9) :903-905, 908. (in Chi-nese) 张汝玲, 陆伦根.胆道疾病的研究现状[J].临床肝胆病杂志, 2011, 27 (9) :903-905, 908. [7]Batts KP.Ischemic cholangitis[J].Mayo Clin Proc, 1998, 73 (4) :380-385. [8]Huo SJ, Fan QS.Blood supply for eatra-hepatic puck and its clin-ical significance[J].Anatony and Clinics, 2004, 9 (2) :76-77. (in Chinese) 霍胜军, 范松青.肝外胆管的动脉血供及其临床意义[J].解剖与临床, 2004, 9 (2) :76-77. [9]Colle I, Van Vlierberghe H, Troisi R, et al.Transplanted liver:consequences of denervation for liver function[J].Anant Rec ADiscov Mol Cell Evol Biol, 2004, 280 (1) :924-931. [10]Neuhuber WL, Tiegs G.Innervation of immune cell:evidence for neu-roimmunomodulation in the liver[J].Anant Rec A Discov Mol CellEvol Biol, 2004, 280 (1) :884-892. [11]Galloway G, Giuliani MJ, Burns DK, et al.Neuropathy associated withhyperoxaluria:improvement after combined renal and liver transplanta-tion[J].Brain Pathol, 1998, 8 (2) :247-251.
计量
- 文章访问数: 3011
- HTML全文浏览量: 11
- PDF下载量: 630
- 被引次数: 0