Abstract:

Objective To study the related factors for significant intraoperative blood loss and their impact on prognosis in children with biliary atresia who underwent liver transplantation for the first time. Methods The data of children with biliary atresia who underwent liver transplantation at the Department of Liver Transplantation，Tianjin First Central Hospital from July 2020 to December 2024 were collected and analyzed. Risk factors for massive estimated blood loss （EBL）were analyzed using univariate logistic regression and multivariate logisticregression analysis. The postoperative complications of the two groups，including hepatic artery embolism， biliary complications， intestinal fistula， etc.，were analyzed and compared by chi square test. Log-rank test and KaplanMeier curve were used to analyze the recipient and graft survival rate of the two groups. Results A total numberof 662 patients with biliary atresia were enrolled in the study. Ninety-nine patients had massive EBL. UnivariateLogistic regression analysis showed that the recipient's age， height，INR，operation time and transplant type were the risk factors of massive EBL during liver transplantation in children with biliary atresia. Multivariate logisticregression analysis showed that prolonged operation time（≥ 10 hours），age ＜ 6.5 months， body hight ＜ 70 cm， transplant with reduced-sized left lateral lobe and INR ≥ 2.35 were important independent risk factors for massive EBL. The incidence of hepatic artery thrombosis ， ischemic biliary complications，intestinal leakage and pulmonaryinfection in massive EBL group were significantly higher than those without massive EBL（9.1% vs. 3.2%，11.1% vs. 5.3%，2.0% vs. 0.9%，25.3% vs. 13.7%，all P ＜ 0.05）. The 3-year recipient survival rate of massive EBL patientswas significantly lower than that of patients without massive EBL（93.9% vs. 97.2%，P ＜ 0.05）. Conclusion For children with biliary atresia who undergo liver transplantation for the first time，the use of reduced-size grafts should be minimized and the surgery time should be shortened to ensure surgical safety. For children without growth disorder， surgery could be performed when the hight reaches 70 cm and the age reaches 6.5 months. Preoperative correction ofcoagulation function when INR drops below 2.35 and reducing intraoperative bleeding is of great significance to the prognosis of children. 

Key words:

Liver transplantation ； , Child ； , Hemorrhage ； , Risk factors ； , Prognosis collaboration ；Nursin

摘要：

目的 探讨接受首次肝移植的胆道闭锁患儿，术中出血的相关影响因素及其对预后的影响。方法 对 2020 年 7 月至 2024 年 12 月在天津市第一中心医院诊断为胆道闭锁并接受首次肝移植的儿童的临床资料进行回顾性分析。使用单因素 Logistic 回归、多因素 Logistic 回归分析手术中大量估计出血量（estimated blood loss，EBL）的相关因素。通过卡方检验比较两组术后并发症发生率，包括肝动脉栓塞、胆道并发症、肠瘘等。通过 Kaplan-Meier 曲线、Log-rank 检验分别比较两组研究对象的总体生存率及移植物存活率。结果 共有 662 例胆道闭锁患儿纳入研究，其中大量 EBL 组 99 例。单因素 Logistic 回归分析显示，移植受者月龄、身高、国际标准化比值（international normalized ratio，INR）、手术时间、移植物类型是胆道闭锁患儿肝移植术中大量 EBL 的相关影响因素。多因素 Logistic 回归分析显示，手术时间≥ 10 h、月龄＜ 6.5 月、受者身高＜ 70 cm、移植物类型为减体积左外叶、INR ≥ 2.35 是胆道闭锁患儿肝移植术中大量 EBL 的独立相关因素（P ＜ 0.05）。术中大量 EBL 组受者术后肝动脉血栓形成、缺血性胆道并发症、肠漏、肺感染的发生率均高于非大量 EBL 组（9.1% 比 3.2%、11.1% 比 5.3%、2.0% 比 0.9%、25.3% 比 13.7%，均 P ＜ 0.05）。结论 对于首次接受肝移植手术的胆管闭锁患儿，为了有效控制术中失血，应减少移植物在体减体积术式的使用。在确保手术安全的同时尽可能缩短手术时间，对于没有成长障碍的患儿，应尽量让患儿年龄大于 6.5 个月、身高增涨至 70 cm 以上，术前纠正凝血功能至 INR 降至 2.35 以下，减少术中出血对改善儿童预

后非常重要。

关键词:

肝移植 , 儿童 , 出血 , 相关因素 , 预后