Schukfeh Nagoud, Holland Anna-Charlotte, Hoyer Dieter P, Gallinat Anja, Paul Andreas, Schulze Maren
Department of General Visceral and Transplant Surgery, Division of Pediatric Surgery, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55D, , 45147, Essen, Germany.
Langenbecks Arch Surg. 2017 Feb;402(1):135-141. doi: 10.1007/s00423-016-1525-x. Epub 2016 Nov 3.
Biliary atresia (BA) is the most frequent disease leading to liver transplantation (LT) in infants. Since the patients often require transplantation before reaching a body weight of 10 kg, it is necessary to perform living-related or split liver transplantation by using a left lateral segment. However, this graft often exceeds a graft body weight ratio (GBWR) of 4. Because of the size mismatch and poor portal venous blood flow in most recipients, temporary abdominal closure is often favoured. The aim of the present study is to investigate the feasibility of primary abdominal closure in this group of extremely small infants undergoing LT.
All patients with the diagnosis of BA and a body weight ≤10 kg who underwent LT in our centre between January 2004 and December 2014 were included in this study. Patients who received primary abdominal closure at transplantation (group 1) were compared with those receiving temporary abdominal closure (group 2). The postoperative clinical and biochemical course was analysed. The outcome was determined and correlated with body and graft weight and the GBWR.
Sixty-six LTs were performed in 57 patients in the study period (22 male, 35 female). Thirty-six patients received primary closure (group 1). Twenty-eight patients received temporary closure (group 2). Mean age at LT was 10 months (range 3-26) and mean GBWR 4.8 (range 2.9-9.3). A GBWR ≥4 occurred in 61.1 % in group 1 and in 60.9 % in group 2. There was no significant difference between both groups concerning body weight, graft weight or GBWR. Vascular thrombosis occurred in 8 patients (22 %) and 15 patients (42 %) in group 1 and in 10 patients (36 %) and 11 patients (39 %) in group 2, respectively. Six patients (17 %) of group 1 and five patients (18 %) of group 2 developed an intraabdominal infection postoperatively. After a mean follow-up of 4.6 years (range 1 month-11.1 years), patient and graft survival were 90.1 and 75 % in group 1 and 78.3 and 64.3 % in group 2, respectively.
In our study, primary abdominal closure displays a similar outcome in comparison to temporary abdominal closure.
胆道闭锁（BA）是导致婴儿肝移植（LT）的最常见疾病。由于患者通常在体重达到10千克之前就需要进行移植，因此有必要使用左外侧段进行活体亲属供肝或劈离式肝移植。然而，这种移植物的移植物体重比（GBWR）往往超过4。由于大多数受者存在尺寸不匹配和门静脉血流不佳的情况，临时腹壁关闭术通常更受青睐。本研究的目的是探讨在这组接受肝移植的极小婴儿中进行一期腹壁关闭的可行性。
本研究纳入了2004年1月至2014年12月期间在我们中心接受肝移植且诊断为BA、体重≤10千克的所有患者。将移植时接受一期腹壁关闭的患者（第1组）与接受临时腹壁关闭的患者（第2组）进行比较。分析术后的临床和生化过程。确定结果并将其与体重、移植物重量和GBWR进行关联。
在研究期间，57例患者接受了66次肝移植（男22例，女35例）。36例患者接受了一期关闭（第1组）。28例患者接受了临时关闭（第2组）。肝移植时的平均年龄为10个月（范围3 - 26个月），平均GBWR为4.8（范围2.9 - 9.3）。第1组中GBWR≥4的情况占61.1%，第2组中占60.9%。两组在体重、移植物重量或GBWR方面无显著差异。第1组分别有8例患者（22%）和15例患者（42%）发生血管血栓形成，第2组分别有10例患者（36%）和11例患者（39%）发生血管血栓形成。第1组有6例患者（17%）和第2组有5例患者（18%）术后发生腹腔内感染。平均随访4.6年（范围1个月 - 11.1年）后，第1组的患者和移植物存活率分别为90.1%和75%；第2组分别为78.3%和64.3%。
在我们的研究中，一期腹壁关闭与临时腹壁关闭相比显示出相似的结果。
