| Objective:To compare the differences in postoperative complications(mainly vascular complications and biliary complications),liver function recovery and survival rates between patients undergoing arterial or portal reconstruction with interposition graft and those who didn't have interposition graft in liver transplantation.Methods:A total of 12 patients with hepatic vascular grafts underwent liver transplantation from November 2011 to September 2016 in the First Affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed.Among them,7 cases of arterial bridge,4 cases of venous bridge,1 case of both arteries and veins bridge as the experimental group,and selected the patients who were admitted to the First Affiliated Hospital of Zhejiang University Medical College from November 2011 to September 2016 for liver transplantation but without vascular bridge(to ensure the portal veins of the supply of liver and the recipient of the host were end-to-end anastomosis),as the control group(a total of 33 cases).Between the arterial,venous graft group and control group,preoperative data including gender,age,ALT,AST,TB,Alb,PT,Child-Pugh score,MELD score(PELD score),whether the tumor and blood type were matched,Cold ischemia time,warm ischemia time,anhepatic phase and biliary anastomosis were not significantly different(p>0.05).The incidence of postoperative vascular complications,biliary complications,hepatic artery and portal blood flow of postoperative day 1,3,5,7 and longer than 1 month,the liver function of postoperative day 1,3,5,7 and the survival of patients on the day when data was recorded.Counting data using chi-square test,measurement data using independent sample t test.Results:The liver function of the arterial/venous graft group and the control group were compared.The levels of alanine aminotransferase(ALT)in the two groups were compared on postoperative day 1,3,5,7 and longer than 1 month.There was no significant difference between the two groups.There was no significant difference between the two groups(P>0.05).and the left and right hepatic artery resistance index(RI)and peak velocity of blood flow were obtained at 1 day,3 days,5 days,7 days and longer than 1 month after liver transplantation,but there was no significant difference in the peak blood flow velocity of the hepatic artery(p>0.05).Compared with the control group,the RI of the arterial graft group was significantly higher than that of the control group on postoperative day 1 and the RI of the arterial graft group was significantly lower than that of the control group on postoperative day 5(p<0.05)(no significant difference on other days(p>0.05)).The peak flow velocity of the right portal vein was significantly lower than that of the control group at 1st day after liver transplantation(P<0.05),and the peak flow velocity of the left portal vein was significantly lower than that of the control group at 5th day after liver transplantation(P<0.05),but there was no significant difference in peak flow velocity between the two groups on other days(p>0.05).comparing postoperative complications,the number of patients who had biliary complications and the number of those who didn't of the arterial/venous graft group were 2:5/0:4,which had no significant difference to that of the control group(4:29)(p>0.05).as for vascular complications,the number of patients who had that and the number of those who didn't of the arterial/venous graft group werel:6/1:3,which had no significant difference to that of the control group(1:32)(p>0.05).The survival rate of the two graft groups was compared with that of the control group.There was no significant difference between the two groups(p>0.05).Conclusion:Vascular interposition graft can be used as a safe and effective alternative to anastomosis in patients undergoing liver transplantation with problems in performing traditional end-to-end anastomosis,since it does not increase postoperative biliary complications and vascular complications,and does not affect the recovery of long-term liver function and the survival rate of patients. |
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