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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。
Objective To compare and analyze the prognosis of biliary atresia living liver transplantation before and after 2010 in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, aimed at exploring the prognosis of surgery at different periods. Methods A retrospective analysis of 101 cases of infantile biliary atresia living donor liver transplantation data from October 2006 to December 2012. According to the different years of transplantation, the case data were divided into two groups from 2006-2009 and 2010-2012, and the general information, intraoperative status and prognosis of the two groups were analyzed and compared. Kaplan-Meier survival analysis, measurement data statistics using t test, count data using Fisher exact test and chi-square test. Results There was no significant difference in preoperative general information between the two groups. The amount of intraoperative blood loss (t = 2.05, P = 0.04) and cold donor ischemia (t = 3.25, P <0.01) were significantly lower in the recipients from 2010 to 2012 than in the 2006-2009 group. The incidence of postoperative biliary complications (χ2 = 4.27, P = 0.04), complications of lung infection (χ2 = 4.47, P = 0.03) and acute rejection (P = 0.03) in 2010-2012 was significantly lower In the 2006-2009 group. The postoperative survival of the recipients from 2010 to 2012 was significantly better than that from 2006-2009. The 1-year and 2-year cumulative survival rate was 88.4% and 88.4% in 2010-2012, compared with 84.4% and 75% in 2006-2009, respectively. Conclusion The accumulation of surgical techniques and perioperative management experience, as well as the gradual improvement and standard follow-up, can improve the success rate of surgery and postoperative survival rate and reduce the incidence of perioperative complications.