血管闭合系统在肝移植门静脉重建中的应用分析：附137例报道

潘冰; 吕少诚; 李立新; 赵昕; 张志华; 李平; 郎韧; 贺强

doi:10.3969/j.issn.1674-7445.2018.04.003

血管闭合系统在肝移植门静脉重建中的应用分析：附137例报道

doi: 10.3969/j.issn.1674-7445.2018.04.003

100020 北京，首都医科大学附属北京朝阳医院肝胆外科

基金项目:

国家自然科学基金 81471590

详细信息

作者简介:
潘冰，男，1991年生，硕士研究生，住院医师，Email：1135970035@qq.com

通讯作者:
贺强，男，1963年生，博士，博士研究生导师，教授，研究方向为肝移植的临床与基础研究，Email：heqiang349@sina.com

中图分类号: R617
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出版历程
- 收稿日期: 2018-04-02
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-07-15

nalysis on the application of vascular closure system in portal vein reconstruction of liver transplantation: report of 137 cases

Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China

More Information

Corresponding author: He Qiang,Email：heqiang349@sina.com

摘要

摘要: 目的分析非穿透性血管闭合系统在成人同种异体肝移植门静脉重建中的应用效果。方法回顾性分析222例同种异体肝移植患者的临床资料。根据术中门静脉重建是否使用血管闭合系统，分为血管夹组（137例）和传统缝合组（85例）。比较两组患者围手术期情况、预后情况和并发症发生情况。结果两组患者均顺利完成手术，血管夹组一次性吻合门静脉的成功率为93.4%（128/137）。本组资料中共有14例患者围手术期死亡，病死率为6.3%（14/222)，两组患者围手术期均未发生门静脉相关并发症。血管夹组的门静脉吻合时间为（5.6±1.7）min，明显短于传统缝合组的（10.7±3.6）min，差异有统计学意义（P < 0.05）。两组患者围手术期并发症发生率及分级比较，差异均无统计学意义（均为P > 0.05）。结论肝移植术中使用血管闭合系统重建门静脉是安全可行的，与传统手工缝合比较，前者能有效缩短门静脉吻合时间。
- 血管闭合系统 /
- 传统缝合 /
- 同种异体原位肝移植 /
- 门静脉 /
- 血管吻合 /
- 手术时间 /
- 围手术期并发症 /
- 血栓
Abstract: Objective To analyze the application effect of non-penetrating vascular closure system in portal vein reconstruction of allogenic liver transplantation in adults. Methods Clinical data of 222 patients undergoing allogeneic liver transplantation were retrospectively analyzed. According to whether vascular closure system was used in portal vein reconstruction during operation, all patients were divided into vascular clip group (n=137) and traditional suture group (n=85). Perioperative conditions, clinical prognosis and complications were statistically compared between two groups. Results All patients successfully completed the surgery. The success rate of one-time portal vein anastomosis was 93.4% (128/137) in the vascular clip group. A total of 14 patients died during perioperative period in this study with a mortality rate of 6.3% (14/222). No portal vein-related complications occurred during perioperative period in both groups. The time of portal vein anastomosis in the vascular clip group was (5.6±1.7) min, which was significantly shorter than (10.7±3.6) min in the traditional suture group (P < 0.05). The incidence and grade of perioperative complications did not significantly differ between two groups (all P > 0.05). Conclusions It is safe and feasible to utilize vascular closure system to reconstruct the portal vein during liver transplantation. Compared with traditional suture, it can effectively shorten the time of portal vein anastomosis.
- Vascular closure system /
- Traditional suture /
- Allogenic orthotopic liver transplantation /
- Portal vein /
- Vascular anastomosis /
- Operative time /
- Perioperative complications /
- Thrombosis

HTML全文

图 1 肝移植术中使用血管闭合系统吻合门静脉过程及术后影像学图片

A图为血管闭合系统；B图为术中血管闭合系统吻合门静脉；C图为术中吻合后的门静脉；D图为术后CT示环形高密度影，为血管吻合的钛钉

Figure 1. Application of vascular closure system to anastomosis of portal vein during liver transplantation and postoperative imaging findings

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表 1 两组患者围手术期情况比较

Table 1. Comparison of perioperative situation of patients between two groups

指标	血管夹组（n=137）	传统缝合组（n=85）	P值
手术时间(x±s, min)	522±119	545±150	0.211
门静脉吻合时间(x±s, min)	5.6±1.7	10.7±3.60	0.000
出血量[M(Q), mL]	1 000(800)	1 000(1 000)	0.882
是否输血[n（%）]
是	105(77)	59(69)	0.233
否	032(23)	26(31)
术后ICU停留时间[M(Q), d]	05(6)	23(11)	0.203
术后住院时间[M(Q), d]	025(13)	5(4)	0.099

下载: 导出CSV

表 2 两组患者围手术期并发症发生率的比较

Table 2. Comparison of the incidence of perioperative complications of patients between two groups[n(%)]

并发症	血管夹组（n=137）	传统缝合组（n=85）	P值
腹腔出血	6（4）	5（6）	0.905
下肢静脉血栓	2（1）	1（1）	0.699
胆漏	2（1）	0	0.521
肠穿孔	5（4）	2（2）	0.848
腹腔感染	10（7）0	4（5）	0.401
肺部感染	8（6）	8（9）	0.358
伤口感染	1（1）	0	1.000
急性排斥反应	3（2）	1（1）	0.944
其他	9（7）	4（5）	0.522

下载: 导出CSV

表 3 两组患者围手术期并发症Clavien系统分级的比较

Table 3. Comparison of Clavien system grade of perioperative complications of patients between two groups [n(%)]

分级	血管夹组（n=137）	传统缝合组（n=85）	P值
Ⅰ级	4（3）	6（7）	0.485
Ⅱ级	9（7）	11（13）
Ⅲ级	19（14）	11（13）
Ⅳ级	2（1）	4（5）
Ⅴ级	8（6）	6（7）

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参考文献(21)

[1]	SCHMITZ V, SCHOENING W, JELKMANN I, et al. Different cava reconstruction techniques in liver transplantation: piggyback versus cava resection[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(3): 242-249. doi: 10.1016/S1499-3872(14)60250-2
[2]	周光文.原位肝移植术后门静脉并发症处理及远期疗效评估[J].器官移植, 2013, 4(6): 335-338. DOI: 10.3969/j.issn.1674-7445.2013.06.006. ZHOU GW. Treatment for portal venous complications after orthotopic liver transplantation and evaluation of long-term curative effect[J]. Organ Transplant, 2013, 4(6): 335-338. DOI: 10.3969/j.issn.1674-7445.2013.06.006.
[3]	SHETH RA, GANGULI S. Closure of alternative vascular sites, including axillary, brachial, popliteal, and surgical grafts[J]. Tech Vasc Interv Radiol, 2015, 18(2): 113-121. DOI: 10.1053/j.tvir.2015.04.009.
[4]	CHU G, YANG W, ZHANG G, et al. Safety and efficacy of the StarClose vascular closure system following 8-Fr sheath placement for intra-aortic balloon pump: a single-center analysis of 42 consecutive patients[J]. Med Princ Pract, 2014, 23(4): 313-317. DOI: 10.1159/000362127.
[5]	NGUYEN KP, TERUYA T, ALABI O, et al. Comparison of nonpenetrating titanium clips versus continuous polypropylene suture in dialysis access creation[J]. Ann Vasc Surg, 2016, 32: 15-19. DOI: 10.1016/j.avsg.2015.11.008.
[6]	AMER O, BINGER S, DESCH S, et al. Incidence, predictors, and treatment options of critical limb ischaemia after use of collagen plug-based vascular closure devices[J]. EuroIntervention, 2015, 11(7): 816-823. DOI: 10.4244/EIJV11I7A166.
[7]	DONKER JM, TIJNAGEL MJ, VAN ZEELAND ML, et al. Anastomoses in the common femoral artery, vascular clips or sutures? a feasibility study[J]. Ann Vasc Surg, 2013, 27(2): 194-198. DOI: 10.1016/j.avsg.2012.02.008.
[8]	刘仕琪, 雷鹏, 吕毅, 等.磁吻合技术实现下腔静脉吻合组织与电镜观察[J].中华实验外科杂志, 2015, 32(2): 258-260. DOI: 10.3760/cma.j.issn.1001-9030.2015.02.015. LIU SQ, LEI P, LYU Y, et al. Histologic and scanning electron microscopic study for inferior vena cava anastomosis by magnetic compressive anastomosis[J]. Chin J Exp Surg, 2015, 32(2): 258-260. DOI: 10.3760/cma.j.issn.1001-9030.2015.02.015.
[9]	BIRTH M, GERBERDING J, MARKERT U, et al. Biliary endo-to-end anastomosis with extramucosal titanium clips. initial results of a new technique[J]. Zentralbl Chir, 2000, 125(12): 990-996.
[10]	杨丽斐, 吕毅.磁吻合技术实现无缝线肝脏快速植入的临床前研究[J].器官移植, 2017, 8(3): 181-185. DOI: 10.3969/j.issn.1674-7445.2017.03.001. YANG LF, LYU Y. Preclinical study of magnetic anatomosis technique for rapid liver transplantation without suture[J]. Organ Transplant, 2017, 8(3): 181-185. DOI: 10.3969/j.issn.1674-7445.2017.03.001.
[11]	MARAJ I, BUDZIKOWSKI AS, ALI W, et al. Use of vascular closure device is safe and effective in electrophysiological procedures[J]. J Interv Card Electrophysiol, 2015, 43(2): 193-195. DOI: 10.1007/s10840-015-0005-5.
[12]	PANTEA S, JIGA L, IONAC M, et al. Arterio-venous fistula using nonpenetrating titanium clips (VCS)[J]. Chirurgia (Bucur), 2013, 108(4):563-567. http://cn.bing.com/academic/profile?id=f2bd6e90241e5695bcffa634cbf15651&encoded=0&v=paper_preview&mkt=zh-cn
[13]	钟外生, 陈杰, 黄文孝, 等.微血管吻合器在游离组织瓣修复头颈部缺损中的临床应用[J].中华显微外科杂志, 2017, 40(1): 25-29. DOI: 10.3760/cma.j.issn.1001-2036.2017.01.009. ZHONG WS, CHEN J, HUANG WX, et al. Application of microvascular device in free-tissue flap reconstruction of head-and-neck defects [J]. Chin J Microsurg, 2017, 40(1): 25-29. DOI: 10.3760/cma.j.issn.1001-2036.2017.01.009.
[14]	LIU SQ, LEI P, CAO ZP, et al. Nonsuture anastomosis of arteries and veins using the magnetic pinned-ring device: a histologic and scanning electron microscopic study[J]. Ann Vasc Surg, 2012, 26(7): 985-995. DOI: 10.1016/j.avsg.2012.04.003.
[15]	KARA K, KAHLERT P, MAHABADI AA, et al. Comparison of collagen-based vascular closure devices in patients with vs. without severe peripheral artery disease[J]. J Endovasc Ther, 2014, 21(1): 79-84. DOI: 10.1583/13-4401MR.1.
[16]	WANG J, WANG J, YOSHINORI A, et al. Low-intensity pulsed ultrasound prompts tissue-engineered bone formation after implantation surgery[J]. Chin Med J (Engl), 2014, 127(4): 669-674. http://cn.bing.com/academic/profile?id=aebf9f9520ab03df34216bbd0045c86b&encoded=0&v=paper_preview&mkt=zh-cn
[17]	王天成, 朱志军, 魏林, 等.45例胆道闭锁婴幼儿亲属活体肝移植术中门静脉重建方式的临床分析[J].中华器官移植杂志, 2016, 37(2): 65-69. DOI: 10.3760/cma.j.issn.0254-1785.2016.02.001. WANG TC, ZHU ZJ, WEI L, et al. Clinical analysis of different surgical approaches of portal vein reconstruction in pediatric living-related liver transplantation for 45 infant patients with biliary atresia[J]. Chin J Organ Transplant, 2016, 37(2): 65-69. DOI: 10.3760/cma.j.issn.0254-1785.2016.02.001.
[18]	TASHIRO H, OHDAN H, ITAMOTO T, et al. Vascular closure staples for portal vein reconstruction in living-donor liver transplantation[J]. Am J Surg, 2005, 190(1): 65-68. doi: 10.1016/j.amjsurg.2004.10.006
[19]	CALLES-VÁZQUEZ MC, RUBIO EA, AYALA VC, et al. Heterotopic renal transplantation in piglets using vascular closure stapler metallic clips or conventional suturing techniques: comparison of vessel growth and macroscopical study[J]. J Pediatr Surg, 2012, 47(7): 1390-1398. DOI: 10.1016/j.jpedsurg.2011.12.015.
[20]	WANG Y, ZHANG M, LIU ZW, et al. The ratio of circulating regulatory T cells (Tregs)/Th17 cells is associated with acute allograft rejection in liver transplantation[J]. PLoS One, 2014, 9(11): e112135. DOI: 10.1371/journal.pone.0112135.
[21]	CALLES-VÁZQUEZ MC, ABELLÁN RUBIO E, AYALA VC, et al. Growing cava vein anastomosis: comparison of cross-clamping and suture times using VCS metallic clips, interrupted nonabsorbable, or continuous absorbable suturing techniques[J]. Ann Vasc Surg, 2013, 27(7): 947-953. DOI: 10.1016/j.avsg.2013.03.005.