切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 446 -449. doi: 10.3877/cma.j.issn.1674-0793.2019.06.006

所属专题： 文献；

论著

肝移植术后持续性胸腔积液的危险因素分析
龚雪屹1, 朱晓峰2,†(), 胡泽民3, 汪谦4   
  1. 1. 510080　广州，中山大学附属第一医院博士后流动站；528403　中山市人民医院普外一科
    2. 510080　广州，中山大学附属第一医院器官移植科
    3. 528403　中山市人民医院普外一科
    4. 510080　广州，中山大学附属第一医院胆胰外科
  • 收稿日期:2018-12-16 出版日期:2019-12-01
  • 通信作者: 朱晓峰
  • 基金资助:
    广东省医学科学基金项目(2015B1092)

Risk factor analysis of the persistent pleural effusion for thoracocentesis treatment after liver transplantion

Xueyi Gong1, Xiaofeng Zhu2,†(), Zemin Hu3, Qian Wang4   

  1. 1. Postdoctoral Programme, the First Affiliated Hospital of SunYat-sen University, Guangzhou 510080, China;The First Department of General Surgery, Zhongshan City People’s Hospital, Zhongshan 528403, China
    2. OrganTransplantation Department, the First Affiliated Hospital of SunYat-sen University, Guangzhou 510080, China
    3. The First Department of General Surgery, Zhongshan City People’s Hospital, Zhongshan 528403, China
    4. Department of Hepatobiliary Surgery, the First Affiliated Hospital of SunYat-sen University, Guangzhou 510080, China
  • Received:2018-12-16 Published:2019-12-01
  • Corresponding author: Xiaofeng Zhu
  • About author:
    Corresponding author: Zhu Xiaofeng, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

龚雪屹, 朱晓峰, 胡泽民, 汪谦. 肝移植术后持续性胸腔积液的危险因素分析[J]. 中华普通外科学文献(电子版), 2019, 13(06): 446-449.

Xueyi Gong, Xiaofeng Zhu, Zemin Hu, Qian Wang. Risk factor analysis of the persistent pleural effusion for thoracocentesis treatment after liver transplantion[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(06): 446-449.

目的

对肝移植术后需穿刺置管引流治疗的胸腔积液并发症进行原因分析，了解其危险因素，从而有效预防及治疗肝移植术后胸腔积液。

方法

回顾性分析2015年1月至2016年12月中山市人民医院52例肝移植患者临床资料，单因素分析持续性胸腔积液胸腔置管引流组和未引流组之间的差异，再建立Logistic多元回归模型分析肝移植术后胸腔置管引流的持续性胸腔积液相关危险因素。

结果

术后48例（92.3%）发生胸腔积液，13例（25.0%）持续性胸腔积液患者需要胸腔置管引流。单因素分析显示术后肺部感染（P=0.005）、胸腔感染（P=0.012）、沙门杆菌感染（P=0.012）、表皮葡萄球菌感染（P=0.013）、白假丝酵母菌感染（P<0.001）、术后胆管并发症（P=0.025）、腹腔置管引流（P=0.003）是术后发生持续性胸腔积液的相关因素。Logistic回归分析显示，肝移植术后肺部感染及腹腔穿刺置管术是患者胸腔穿刺置管引流持续性胸腔积液的危险因素，其中肺部感染患者行胸腔置管引流持续性胸腔积液的风险是无肺部感染患者的7.354倍（P=0.027），术后腹腔置管引流术患者行胸腔置管引流的风险为术后无腹腔置管引流术患者的31.601倍（P=0.012）。

结论

肝移植术后应密切观察患者病情，积极预防肺部感染，减少腹腔穿刺置管引流，以有效控制持续性胸腔积液的发生。

关键词: 肝移植, 手术后并发症, 胸腔积液, 引流术
Objective

To analyze the reasons of persistent pleural effusion complications after liver transplantation and to understand the risk factors, so as to effectively prevent and treat pleural effusion after liver transplantation.

Methods

From January 2015 to December 2016, the clinical data of fifty-two patients with liver transplantation in Zhongshan City People’s Hospital were retrospectively analyzed. Univariate analysis was carried out for the difference between the continuous pleural effusion group and the non-drainage group after thoracic catheterization. Logistic multiple regression model was established to analyze the risk factors of persistent pleural effusion after thoracic catheterization and drainage after liver transplantation.

Results

There were 48 cases (92.3%) of pleural effusion after operation, and 13 cases (25.0%) needed thoracic catheter drainage for persistent pleural effusion. Univariate analysis showed that pulmonary infection (P=0.005), thoracic infection (P=0.012), Salmonella infection (P=0.012), Staphylococcus epidermidis infection (P=0.013), Candida albicans infection (P<0.001), postoperative biliary complications (P=0.025), and abdominal catheter drainage (P=0.003) were the related factors of persistent pleural effusion after operation. Logistic regression analysis showed that pulmonary infection (OR=7.354,P=0.027), abdominal puncture and catheterization (OR=31.601,P=0.012) were risk factors for persistent pleural effusion after liver transplantation.

Conclusion

The occurrence of persistent pleural effusion can be effectively controlled by closely observing the condition after liver transplantation, actively preventing pulmonary infection and reducing abdominal puncture and catheter drainage.

Key words: Liver transplantation, Postoperative complications, Pleural effusion, Drainage
表1 单因素分析肝移植术后发生持续性胸腔积液的相关因素（例）
项目 胸腔置管引流术 χ2值 P值
无 有
肺部感染 ? ? ? ?
? 否 29 4 7.989 0.005
? 是 10 9 ? ?
胸腔感染 ? ? ? ?
? 否 39 11 6.241 0.012
? 是 0 2 ? ?
沙门杆菌感染 ? ? ? ?
? 否 39 11 6.241 0.012
? 是 0 2 ? ?
表皮葡萄球菌感染 ? ? ? ?
? 否 39 10 9.551 0.013
? 是 0 3 ? ?
白假丝酵母菌感染 ? ? ? ?
? 否 39 9 13.000 <0.001
? 是 0 4 ? ?
胆管并发症 ? ? ? ?
? 无 35 11 7.362 0.025
? 胆管吻合口狭窄 4 0 ? ?
? 胆总管狭窄 0 2 ? ?
腹腔置管引流术 ? ? ? ?
? 无 38 9 8.925 0.003
? 有 1 4 ? ?
表2 影响肝移植术后胸腔置管引流持续性胸腔积液Logistic多变量分析
因素 β SE Wals df Sig. Exp (β) 95%CI
肺部感染 1.995 0.902 4.891 1 0.027 7.354 1.255~43.096
表皮葡萄球菌 21.263 20 733.142 0 1 0.999 1 716 333 880 <0.001
腹腔置管引流术 3.453 1.373 6.329 1 0.012 31.601 2.144~456.722
常量 -2.671 0.732 13.312 1 0 0.069 -
[9]
Yost CS, Matthay MA, Gropper MA. Etiology of acute pulmonary edema during liver transplantation: A series of cases with analysis of the edema fluid[J]. Chest, 2001, 119(1): 219-223.
[10]
安玉玲, 傅斌生, 吕海金, 等. 肝移植术后早期优化气道湿化和雾化吸入方案的疗效分析[J/CD]. 中华移植杂志(电子版), 2015, 9(4): 160-164.
[11]
Massicotte L, Sassine MP, Lenis S, et al. Survival rate changes with transfusion of blood products during liver transplantation[J]. Can J Anaesth, 2005, 52(2): 148-155.
[12]
Cacciarelli TV, Keeffe EB, Moore DH, et al. Primary liver transplantation without transfusion of red blood cells[J]. Surgery, 1996, 120(4): 698-704; discussion 704-705.
[13]
Cacciarelli TV, Keeffe EB, Moore DH, et al. Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation[J]. Arch Surg, 1999, 134(1): 25-29.
[14]
Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis[J]. Liver Transpl, 2007, 13(8): 1174-1180.
[1]
KH Melamed, Natasha Cuk, Ramy Salah, et al. Trapped lung and pleural effusion in the post orthotopic liver transplant patient[J]. Am J Respir Crit Care Med, 2017, 195: A3534.
[2]
Bozbas SS, Eyuboglu FO, Ozturk EF, et al. Pulmonary complications and mortality after liver transplant[J]. Exp Clin Transplant, 2008, 6(4): 264-270.
[3]
Hong SK, Hwang S, Lee SG, et al. Pulmonary complications following adult liver transplantation[J]. Transplant Proc, 2006, 38(9): 2979-2981.
[4]
Siniscalchi A, Cucchetti A, Toccaceli L, et al. Pretransplant model for end-stage liver disease score as a predictor of postoperative complications after liver transplantation[J]. Transplant Proc, 2009, 41(4): 1240-1242.
[5]
Xia D, Yan LN, Xu L, et al. Postoperative severe pneumonia in adult liver transplant recipients[J]. Transplant Proc, 2006, 38(9): 2974-2978.
[6]
Jiang GQ, Peng MH, Yang DH. Effect of perioperative fluid therapy on early phase prognosis after liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2008, 7(4): 367-372.
[7]
Pirat A, Ozgur S, Torgay A, et al. Risk factors for postoperative respiratory complications in adult liver transplant recipients[J]. Transplant Proc, 2004, 36(1): 218-220.
[8]
Snowden CP, Hughes T, Rose J, et al. Pulmonary edema in patients after liver transplantation[J]. Liver Transpl, 2000, 6(4): 466-470.
[1] 夏效泳, 王立超, 朱治国, 丛云海, 史宗新. 深度塌陷性胫骨平台骨折的形态特点和治疗策略[J]. 中华关节外科杂志(电子版), 2023, 17(05): 625-632.
[2] 李坤河, 寇萌佳, 邝立挺. 肝移植术后二次气管插管的危险因素及预测模型的建立[J]. 中华普通外科学文献(电子版), 2023, 17(05): 366-371.
[3] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[4] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[5] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[6] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[7] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[8] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[9] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[10] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[11] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[12] 李秉林, 吕少诚, 潘飞, 姜涛, 樊华, 寇建涛, 贺强, 郎韧. 供肝灌注液病原菌与肝移植术后早期感染的相关性分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 656-660.
[13] 吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[14] 崔佳琪, 吴迪, 陈海艳, 周惠敏, 顾元龙, 周光文, 杨军. TACE术后并发肝脓肿的临床诊治分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 688-693.
[15] 运陌, 李茂芳, 王浩, 刘东远. 微创穿刺引流联合吡拉西坦、乌拉地尔治疗基底节区高血压性脑出血的临床研究[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 278-285.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号