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目的探讨儿童终末期肝病模型(PELD)评分系统用于预测婴幼儿活体肝移植预后的作用。方法回顾性分析2006年10月至2012年12月上海交通大学医学院附属仁济医院肝脏外科收治的101例小儿活体肝移植临床资料。患儿术前诊断均为胆道闭锁。术前对每例患儿进行PELD评分,根据PELD评分将患儿分为两组:低分组(PELD评分<16分,62例)和高分组(PELD评分≥16分,39例)。比较两组患儿围手术期的基本情况及术后并发症发生率。结果两组患儿的手术年龄和体重差异均有统计学意义(均为P<0.05),但两组性别、移植物(肝)重量/受体的体重、供肝冷缺血时间、术中失血量等差异均无统计学意义(均为P>0.05)。PELD高分组患儿移植术后的肺部感染和胆道并发症发生率均明显高于低分组(均为P<0.05)。结论术前PELD评分可用于预测婴幼儿肝移植的预后,为婴幼儿肝移植的围手术期的治疗、监护及护理措施的制定提供参考。对于术前PELD评分较高的患儿,应加强围手术期并发症的监护处理。
Objective To investigate the use of the pediatric end-stage liver disease (PELD) scoring system in predicting the prognosis of living-donor liver transplantation in infants and young children. Methods A retrospective analysis of 101 cases of pediatric living donor liver transplantation admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2006 to December 2012 was performed. Preoperative diagnosis of children with biliary atresia. The PELD score of each child was preoperatively divided into two groups according to PELD score: low score (PELD score <16 points, 62 cases) and high score group (PELD score ≥16 points, 39 cases). The perioperative conditions and the incidence of postoperative complications were compared between the two groups. Results There were significant differences in age and weight of operation between the two groups (all P <0.05). However, the gender, weight of graft (liver) / body weight of recipient, cold ischemia time, Blood loss and other differences were not statistically significant (all P> 0.05). The incidence of pulmonary infection and biliary complications after transplantation in children with PELD were significantly higher than those in the low group (all P <0.05). Conclusions The preoperative PELD score can be used to predict the prognosis of infants with liver transplantation and provide a reference for the perioperative treatment, care and nursing of infants and children with liver transplantation. For preoperative PELD score higher children, should strengthen the perioperative complications of care treatment.