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再次探讨活体右半肝肝移植术后再次探查的原因、发生率、结果和危险因素。

A retrospective analysis of re-exploration after living donor right lobe liver transplantation: incidence, causes, outcomes, and risk factors.

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Transpl Int. 2019 Feb;32(2):141-152. doi: 10.1111/tri.13335. Epub 2018 Oct 2.

Abstract

Despite technical difficulties, right lobe liver grafting is preferred in living donor liver transplantation because of the graft size. Re-exploration after living donor right lobe liver transplantation (LRLT) has never been separately analyzed. We aimed to analyze the incidence, causes, outcomes, and risk factors of re-exploration after LRLT. We reviewed medical records of 1016 LRLT recipients from October 2003 to July 2017 and identified recipients who underwent re-exploration within hospital stay. Separate analyses were also performed according to cause of re-exploration. The overall incidence of re-exploration was 17.0% (173/1016). The most common cause of re-exploration was bleeding (50%). Overall re-exploration was associated with clinical outcome, but different results were shown on analyses according to cause of re-exploration. Risk factors of re-exploration were underlying hepatocellular carcinoma and operative duration [Odds ratio (OR), 1.49; 95% confidence interval (CI), 1.05-2.12; P = 0.03, and OR, 1.002; 95% CI, 1.001-1.004; P = 0.0023, respectively]. Re-exploration after LRLT is relatively common, and is strongly associated with mortality and graft failure.

摘要

尽管存在技术困难,但由于移植物的大小,右叶肝移植在活体供肝移植中更受欢迎。活体右叶肝移植(LRLT)后的再次探查从未单独进行过分析。我们旨在分析 LRLT 后再次探查的发生率、原因、结果和危险因素。我们回顾了 2003 年 10 月至 2017 年 7 月 1016 例 LRLT 受者的病历,并确定了在住院期间接受再次探查的受者。还根据再次探查的原因进行了单独分析。再次探查的总发生率为 17.0%(173/1016)。再次探查最常见的原因是出血(50%)。总体再次探查与临床结果相关,但根据再次探查的原因进行分析时,结果有所不同。再次探查的危险因素是潜在的肝细胞癌和手术时间[比值比(OR),1.49;95%置信区间(CI),1.05-2.12;P=0.03,和 OR,1.002;95%CI,1.001-1.004;P=0.0023]。LRLT 后的再次探查较为常见,与死亡率和移植物失功密切相关。

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