活体肝移植术后第七日综合征临床特点及治疗  

Clinical Features and Treatment of Seventh Day Syndrome Following Living Donor Liver Transplantation

作　　者：张中伟[1] 王波[1] 尹万红[1] 邓丽静[1] 康焰[1] 卢强[2] 曹丽丽[3] 周琰[1] 

机构地区：[1]四川大学华西医院ICU,成都610041 [2]四川大学华西医院超声诊断科,成都610041 [3]成都大学医护学院,成都610091

出　　处：《四川大学学报（医学版）》2010年第5期903-906,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨活体肝移植(LDLT)术后第七日综合征临床特点及防治措施。方法回顾性分析2002年1月至2009年3月期间244例成人LDLT中发生的8例第七日综合征患者临床资料,包括肝肾功能、凝血功能、彩色多普勒超声、病理检查及各种治疗的效果。结果第七日综合征患者临床特点:①发病前患者一般情况和肝功能恢复顺利,肝功能迅速恶化主要发生在术后1~2周,随后很快发生肾功能衰竭;②彩色多普勒发现门静脉出现血流速度明显下降甚至双向或反向血流;③病理检查发现大片肝细胞凝固性坏死;发生率为3.3%,死亡率为87.5%。甲基强的松龙冲击或抗CD3抗体(OKT3)治疗基本无效,而延长术后静脉甲基强的松龙疗程似乎可以降低发生率,延迟发病时间,减轻肝功能恶化程度,改善生存率。结论 LDLT术后第七日综合征可能由免疫因素介导,目前仍缺乏详尽资料,预防和治疗都很困难。Objective To investigate the clinic features and treatment of Seventh Day Syndrome(7DS) following living donor liver transplantation(LDLT).Methods From January 2002 to March 2009,8 patients were diagnosed with 7DS following LDLT.A retrospective analysis was made on the clinical data containing liver and renal functions,coagulation function,sonographic and histological features and effectiveness of the treatments.Results Rapid deterioration of liver function happened 1-2 weeks after operations,followed by renal dysfunction.There was a reduction of velocity or bidirectional blood flow in the portal vein.Massive coagulative necrosis with disruption of lobular architecture occurred in 3.3% of cases,with a mortality of 87.5%.The steroid pulse and OKT3(anti-CD3 antibody) therapy showed minimal effects.Prolonged application of i.v.methylprednisolone may be helpful with the delay of 7DS.Conclusion The 7DS may be an immune-mediated graft failure.The prevention and control of 7DS is difficult due to lack of research evidence.

关 键 词：七日综合征 活体肝移植 临床特点 治疗 

分 类 号：R657.3[医药卫生—外科学]