分析肝移植术中门静脉主干血流充足的受者直径≥1 cm的分流血管是否需要结扎。

回顾性分析天津市第一中心医院器官移植科2015年1月1日至2018年10月30日76例巨大门静脉分流血管原位肝移植受者临床资料。所有受者门静脉分流血管直径≥1 cm，肝移植术中再灌注后门静脉血流为100～250 mL·100 g^-1·min^-1。根据术中是否结扎分流血管分为结扎组(43例)和非结扎组(33例)。观察结扎组和未结扎组受者围手术期资料、术后生存期以及术后移植肝功能障碍和并发症发生情况。采用成组或配对t检验比较正态分布计量资料，采用秩和检验比较非正态分布计量资料，采用卡方检验或Fisher确切概率法比较计数资料。采用Kaplan-Meier法绘制生存曲线，log-rank检验比较生存率。P<0.05为差异有统计学意义。

结扎组再灌注后结扎分流血管，门静脉主干血流由(120±25)上升至(182±66)mL·100 g^-1·min^-1，差异有统计学意义(t＝5.761，P<0.05)。非结扎组和结扎组再灌注后门静脉主干血流分别为(127±24)、(182±66) mL·100 g^-1·min^-1，差异有统计学意义(t＝4.556，P<0.05)。结扎组受者术后Clavien Ⅲ～Ⅳ级并发症发生率(18.6%，8/13)低于非结扎组(42.4%，14/33)，差异有统计学意义(χ²＝5.15，P<0.05)。随访至2020年10月，两组受者术后均未发生移植物原发性无功能，无死亡和门静脉相关并发症，门静脉均流量充足。结扎组受者术后移植肝功能障碍发生率(7.0%，3/43)低于非结扎组(30.3%，10/33)，差异有统计学意义(χ²＝7.165，P<0.05)。结扎组受者术后1、2和3年生存率分别为88.4%、86.2%和85.2%，非结扎组分别为85.5%、83.1%和81.9%，两组差异无统计学意义(χ²＝0.385、0.344和0.327，P均>0.05)。

对术中门静脉主干血流充足(100～250 mL·100 g^-1·min^-1)的原位肝移植受者，仍建议结扎直径≥1 cm的门静脉分流血管。

To determine whether large (diameter is greater than or equal to 1 cm) portal shunt should be ligated in liver transplantation recipients with adequate intraoperative portal flow.

The clinical data of 76 recipients (all the donors were from organ donation after citizen′s death) who received orthotopic liver transplantation were retrospectively analyzed in the Organ Transplantation Department of Tianjin First Central Hospital from January 1, 2015, to October 30, 2018. The diameter of portal shunt vessels in all recipients was ≥1 cm, and the portal vein blood flow after reperfusion in liver transplantation was 100-250 mL·100 g^-1·min^-1. The recipients were divided into ligation group (43 cases) and non-ligation group (33 cases) according to whether shunt vessels were ligated during operation. The perioperative data, postoperative survival, postoperative transplant liver dysfunction and complications in the ligated group and the unligated group were observed. The group or paired t test was used to compare the data with normal distribution, the rank sum test was used to compare the data with non-normal distribution, and the Chi-square test or Fisher′s exact probability method was used to compare the enumeral data. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to compare the survival rates. P<0.05 was considered statistically significant.

In the ligation group, the main portal vein blood flow increased from (120±25) mL·100 g^-1·min^-1 to (182±66) mL·100 g^-1·min^-1 after reperfusion, and the difference was statistically significant (t=5.761, P<0.05). The main portal vein blood flow after reperfusion was (127±24) mL·100 g^-1·min^-1 in the non-ligation group and (182±66) mL·100 g^-1·min^-1 in the ligation group, and the difference was statistically significant (t=4.556, P<0.05). The incidence of postoperative Clavien Ⅲ-Ⅳ complications in the ligation group (8 cases, 18.6%) was lower than that in the non-ligation group (14 cases, 42.4%), which had statistical significance (χ²=5.15, P<0.05). All the recipients were followed up until October 2020, no primary graft infunction, death or portal vein related complications were found in the 2 groups, and the portal vein had sufficient flow. The incidence of transplant liver dysfunction in the ligation group (7.0%, 3/43) was lower than that in the non-ligation group (30.3%, 10/33), the difference was statistically significant (χ²=7.165, P<0.05). The 1, 2 and 3 year survival rates in the ligation group were 88.4%, 86.2% and 85.2%, respectively, and those in the non-ligation group were 85.5%, 83.1% and 81.9%, respectively, with no significant difference between the 2 groups (χ²=0.385, 0.344 and 0.327, all P>0.05).

For orthotopic liver transplantation recipients with sufficient intraoperative flow of the main portal vein (100-250 mL·100 g^-1·min^-1), ligation of portal vein shunt vessels with diameter ≥1 cm is still recommended.