Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Am Coll Surg. 2014 Dec;219(6):1134-42.e2. doi: 10.1016/j.jamcollsurg.2014.09.006. Epub 2014 Sep 16.
Thoracic fluid retention after living donor liver transplantation (LDLT) has various negative consequences, including atelectasis, pneumonia, and respiratory distress or failure.
We analyzed the clinical impact of preemptive thoracic drainage in 177 patients undergoing adult-to-adult LDLT for chronic liver diseases at a single center. Recipients were divided into 2 time periods. The earlier cohort (n = 120) was analyzed for risk factors for postoperative atelectasis retrospectively; the later cohort (n = 57), with a risk factor for postoperative atelectasis, underwent preemptive thoracic drainage prospectively. The incidence of postoperative pulmonary complications was compared between these 2 cohorts.
Independent risk factors for atelectasis in earlier cohort were body mass index ≥27 kg/m(2) (p < 0.001), performance status ≥3 (p = 0.003) and model for end-stage liver disease score ≥23 (p = 0.005). The rates of atelectasis (21.1% vs 42.5%, p = 0.005) and pneumonia (1.8% vs 10.0%, p = 0.049) were significantly lower in later than in earlier cohort. Moreover, the mean durations of ICU stay (3.6 ± 0.2 days vs 5.7 ± 0.6 days, p = 0.038) and postoperative oxygen support (5.1 ± 0.8 days vs 7.1 ± 0.5 days, p = 0.037) were significantly shorter in the later than in the earlier cohort. There were no significant differences in the incidence of adverse events associated with thoracic drainages between these 2 cohorts.
Preemptive thoracic drainage for transplant recipients at high risk of postoperative atelectasis could decrease morbidities after LDLT.
活体肝移植（LDLT）后胸腔积液会导致多种不良后果，包括肺不张、肺炎、呼吸窘迫或衰竭。
我们在单中心分析了 177 例行成人对成人 LDLT 的慢性肝病患者预防性胸腔引流的临床影响。将患者分为 2 个时期。较早的队列（n = 120）回顾性分析了术后肺不张的危险因素；对于有术后肺不张危险因素的较晚队列（n = 57），前瞻性地进行了预防性胸腔引流。比较了这两个队列术后肺部并发症的发生率。
较早队列中肺不张的独立危险因素为体重指数≥27kg/m²（p < 0.001）、体力状态≥3（p = 0.003）和终末期肝病模型评分≥23（p = 0.005）。较晚队列中肺不张（21.1% vs 42.5%，p = 0.005）和肺炎（1.8% vs 10.0%，p = 0.049）的发生率显著降低。此外，较晚队列中 ICU 停留时间（3.6 ± 0.2 天 vs 5.7 ± 0.6 天，p = 0.038）和术后吸氧时间（5.1 ± 0.8 天 vs 7.1 ± 0.5 天，p = 0.037）明显缩短。这两个队列之间与胸腔引流相关的不良事件发生率没有显著差异。
对于有术后肺不张高风险的移植受者，预防性胸腔引流可降低 LDLT 后的发病率。
