经下腔静脉逆行灌注对肝移植术后早期肾功能的影响

连锦锋; 江艺; 胡还章; 蔡秋程

doi:10.3969/j.issn.1001-5256.2017.12.026

经下腔静脉逆行灌注对肝移植术后早期肾功能的影响

DOI: 10.3969/j.issn.1001-5256.2017.12.026

1. 福建医科大学福总临床医学院
2. 福州总医院肝胆外科

详细信息

中图分类号: R657.3
计量
- 文章访问数: 2056
- HTML全文浏览量: 48
- PDF下载量: 435
- 被引次数: 0
出版历程
- 收稿日期: 2017-06-19
- 出版日期: 2017-12-20

Effect of retrograde perfusion via the inferior vena cava on renal function in the early stage after liver transplantation

School of Clinical Medicine, Fujian Medical University

摘要

摘要:
目的探讨经下腔静脉逆行灌注对肝移植术后早期肾功能的影响。方法回顾性分析福州总医院2000年1月-2012年12月行肝移植患者（术前血清肌酐和尿素氮均正常）共103例。依据术中手术方式的不同分为经典原位肝移植组（A组）26例和经下腔静脉逆灌注肝移植组（B组）77例。比较分析2组患者的术前资料包括年龄、性别、原发病（肝癌/肝硬化）、肝功能MELD评分、术中下腔静脉阻断时间、术中输液总量和输血制品总量,以及术后第17、14、28天尿量、血肌酐水平和血尿素氮水平。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果 B组的下腔静脉阻断时间、术中输液总量和术中输血制品总量均明显低于A组,且差异均有统计学意义（t值分别为9.945、3.127、5.852,P值均<0.05）。2组患者术后急性肾衰竭的发生率差异无统计学意义（χ2=1.920,p>0.05）。A组患者术后第1、2天的尿量明显高于B组且差异有统计学意义（t值分别为3.613、2.929,P值均<0.05）;术后第27、14、28天B组患者的血清肌酐值明显低于...
- 肝移植 /
- 再灌注 /
- 肾疾病
Abstract:
Objective To investigate the effect of retrograde perfusion via the inferior vena cava on renal function in the early stage after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 103 patients with normal serum creatinine and blood urea nitrogen before surgery who underwent liver transplantation in Fuzhou General Hospital from January 2000 to December 2012. According to the surgical approach, these patients were divided into groups A ( orthotopic liver transplantation, 26 patients) and B ( retrograde perfusion via the inferior vena cava, 77 patients) . The two groups were compared in terms of preoperative data [age, sex, primary diseases ( liver cancer/liver cirrhosis) , Model for End-Stage Liver Disease ( MELD) score], time of inferior vena cava occlusion during surgery, intraoperative infusion volume and total volume of blood products, and urine volume, serum creatinine, and blood urea nitrogen at 1-7, 14, and 28 days after surgery. The independent samples t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with group A, group B had a significantly shorter time of inferior vena cava occlusion and significantly lower intraoperative infusion volume and total volume of blood products ( t = 9. 945, 3. 127, and 5. 852, all P < 0. 05) . There was no significant difference in the incidence rate of acute renal failure after surgery between the two groups ( χ2= 1. 920, P > 0. 05) . At 1-2 days after surgery, group A had a significantly higher urine volume than group B ( t = 3. 613 and 2. 929, both P < 0. 05) ; at 2-7, 14, and 28 days after surgery, group B had significantly lower serum creatinine than group A ( t =2. 779, 2. 009, 2. 126, 2. 602, 1. 998, 2. 026, 2. 609, and 3. 870, all P < 0. 05) ; at 1-7, 14, and 28 days after surgery, group B had significantly lower blood urea nitrogen than group A ( t = 5. 895, 3. 212, 1. 830, 2. 348, 3. 030, 3. 549, 2. 287, 2. 996, and 2. 775, all P <0. 05) . Conclusion Retrograde perfusion via the inferior vena cava has little impact on renal function after surgery and brings benefits to the improvement and recovery of renal function after surgery.
- liver transplantation /
- reperfusion /
- kidney diseases

HTML全文

参考文献(27)

[1]STARZL TE, MARCHIORO TL, VON KAULLA KN, et al.Homotransplantation of the liver in humans[J].Surg Gynecol Obstet, 1963, 117:659-676.

[2]HILMI IA, DAMIAN D, AL-KHAFAJI A, et al.Acute kidney injury after orthotopic liver transplantation using living donor versus deceased donor grafts:a propensity score-matched analysis[J].Liver Transpl, 2015, 21 (12) :1560-1561.

[3]KOO M, SABMEA, RAMOS E, et al.Factors related to renal dysfunction after liver transplantation in patients with normal preoperative function[J].Rev Esp Anestesiol Reanim, 2006, 53 (9) :538-544.

[4] PARAJULI S, FOLEY D, DJAMALI A, et al.Renal function and transplantation in liver disease[J].Transplantation, 2015, 99 (9) :1756.

[5]SANG BH, BANG JY, SONG JG, et al.Hypoalbuminemia within two postoperative days is an independent risk factor for acute kidney injury following living donor liver transplantation:a propensity score analysis of 998 consecutive patients[J].Crit Care Med, 2015, 43 (12) :2552-2561.

[6]UMBRO I, ROSSI M, TINTI F, et al.Stages of early acute renal dysfunction in liver transplantation:the influence of graft function[J].Transplant Proc, 2012, 44 (7) :1953-1955.

[7]O’RIORDAN A, WONG V, Mc QUILLAN R, et al.Acute renal disease, as defined by the RIFLE criteria, post-liver transplantation[J].Am J Transplant, 2007, 7 (1) :168-176.

[8]LI XY, LUO GJ, LI SR, et al.Occurrence and survival analysis of acute kidney injury in patients with normal BUN and SCr in the early post-liver transplantation period[J].J Sun Yat-Sen Univ:Medical Sciences, 2013, 34 (3) :397-401. (in Chinese) 李晓芸, 罗刚健, 黎尚荣, 等.术前血肌酐和尿素氮正常患者肝移植早期急性肾损伤的发生与生存分析[J].中山大学学报:医学科学版, 2013, 34 (3) :397-401.

[9]LEI LH, YANG Y, WEI ZY, et al.Value of neutrophil gelatinase associated lipocalin on early diagnosis of acute kidney injury after orthotopic liver transplantation[J].Med J The Chin People's Armed Police Force, 2016, 27 (5) :437-439. (in Chinese) 雷联会, 杨洋, 韦中余, 等.检测NGAL对成人肝移植术后急性肾损伤的早期诊断价值[J].武警医学, 2016, 27 (5) :437-439.

[10]WEI YG, LI B, YAN LN, et al.An analysis of risk factors leading to liver-transplantation acute renal failure[J].Chin Arch Gen Surg, 2006, 21 (1) :7-9. (in Chinese) 魏永刚, 李波, 严律南, 等.肝移植术后急性肾功能衰竭危险因素分析[J].中华普通外科杂志, 2006, 21 (1) :7-9.

[11]ZHANG Q, CHEN H, CHEN XG, et al.Prognostic factors affecting survival after liver transplantation for hepatocellular carcinoma patients with hepatitis B virus infection and cirrhosis[J/CD].Prac J Organ Transpl:Electr Vers, 2015, 3 (4) :215-221. (in Chinese) 张庆, 陈虹, 陈新国, 等.乙型肝炎相关性肝癌肝移植术后远期生存风险因素的分析[J/CD].实用器官移植电子杂志, 2015, 3 (4) :215-221.

[12]KARAPANAGIOTOU A, KYDONA C, DIMITRIADIS C, et al.A-cute kidney injury after orthotopic liver transplantation[J].Transplant Proc, 2012, 44 (9) :2727-2729.

[13]NARCISO RC, FERRAZ LR, MIES S, et al.Impact of acute kidney injury exposure period among liver transplantation patients[J].BMC Nephrology, 2013, 14:43.

[14]WANG HB, LUO Y, ZHANG FJ, et al.Effects of different reperfusion approaches on hemodynamics and early postoperative hepatic and renal function in orthotopic liver transplantation[J].Shanghai Med J, 2011, 34 (12) :927-931. (in Chinese) 王海滨, 罗艳, 张富军, 等.原位肝移植手术不同开放方式对循环及早期肝、肾功能的影响[J].上海医学, 2011, 34 (12) :927-931.

[15]KNICPCISS D, IBERER F, GRASSER B, et al.A single-center experience with retrograde reperfusion in liver transplantation[J].Transpl Int, 2003, 16 (10) :730-735.

[16]DANIEIA K, MICHAEI Z, FIORIAN I, et al.Influence of retrograde flushing via the caval vein on the post-reperfusion syndrome in liver transplantation[J].Clin Transplant, 2004, 18 (6) :638-641.

[17]LYU LZ, JIANG Y, HU HZ, et al.Study on the influences of injurys by ischemia and reperfusion to retrograde perfusion in standard orthotopic liver transplantations[J/CD].Chin Arch Gen Surg:Electr Vers, 2007, 1 (2) :101-105. (in Chinese) 吕立志, 江艺, 胡还章, 等.经典原位肝移植术中逆灌注法对移植肝缺血再灌注损伤的影响[J/CD].中华普通外科学文献:电子版, 2007, 1 (2) :101-105.

[18]LYU LZ, CAI QC, ZHANG XJ, et al.Influence of retrograde reperfusion via vena cana on pulmonary complications after orthotopic liver transplantation[J/CD].Chin Arch Gen Surg:Electr Vers, 2011, 5 (1) :3-6. (in Chinese) 吕立志, 蔡秋程, 张小进, 等.原位肝移植逆灌注法对术后肺部并发症的影响[J/CD].中华普通外科学文献:电子版, 2011, 5 (1) :3-6.

[19]CHENG Y, CAI QC, JIANG Y.Application progress of retrograde reperfusion of inferior vena cava in orthotopic liver transplantation[J].Chin J Organ Transplat, 2016, 7 (6) :479-483. (in Chinese) 程远, 蔡秋程, 江艺.下腔静脉逆行再灌注法在原位肝移植中的应用进展[J].器官移植, 2016, 7 (6) :479-483.

[20]QIAN YB, CHEN GH, HUANG JF.Multivariate regression analysis on early mortality after orthotopic liver transplantation[J].Chin J Organ Transpl, 2002, 23 (3) :161-163. (in Chinese) 钱叶本, 陈规划, 黄洁夫.肝移植患者术后早期死亡原因分析[J].中华器官移植杂志, 2002, 23 (3) :161-163.

[21]LONGENECKER JC, ESTRELLA MM, SEGEV DL, et al.Patterns of kidney function before and after orthotopic liver transplant:associations with length of hospital stay, progression to end-stage renal disease, and mortality[J].Transplantation, 2015, 99 (12) :2556.

[22]PARAJULI S, FOLEY D, DJAMALI A, et al.Renal function and transplantation in liver disease[J].Transplantation, 2015, 99 (9) :1756.

[23]SHARMA P, SCHAUBEL DE, GUIDINGER MK, et al.Impact of MELD-based allocation on end-stage renal disease after liver transplantation[J].Am J Transplant, 2011, 11 (11) :2372.

[24]CABEZUELO JB, RAMIREZ P, ACOSTA F, et al.Prognostic factors of early acute renal failure in liver transplantation[J].Transplant Proe, 2002, 34 (1) :254-255.

[25]HEIDENHAIN C, HEISE M, JONAS S, et al.Retrograde reperfusion via vena cava lowers the risk of initial nonfunction but increases the risk of ischemic-type biliary lesions in liver transplantation-a randomized clinical trial[J].Transpl Int, 2006, 19 (9) :738-748.

[26]SRINIVASAN PK, YAGI S, NAGAI K, et al.Impact of oxygen free radicals in rat partial liver transplantation[J].J Surg Res, 2014, 191 (2) :469-475.

[27]ZHANG XX, BIAN RJ, WANG J, et al.Relationship between cytokine gene polymorphisms and acute rejection following liver transplantation[J].Genet Mol Res, 2016, 15 (2) :gmr.15027599.

施引文献

资源附件(0)

访问统计