原位肝移植术后颅内出血原因和处理  

Causes and treatment of intracranial hemorrhage after orthotopic liver transplantation

作　　者：马毅[1] 叶智明[1] 孙灿辉[1] 朱晓峰[1] 何晓顺[1] 王东平[1] 王国栋[1] 胡安斌[1] 鞠卫强[1] 巫林伟[1] 邰强[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广东广州510080

出　　处：《中国实用外科杂志》2011年第8期703-704,共2页Chinese Journal of Practical Surgery

基　　金：广东省科技计划项目(No:2008B030301296);广东省自然科学基金(9151008901000052)资助

摘　　要：目的探讨肝移植术后颅内出血的临床特点以及防治措施。方法回顾性分析中山大学附属第一医院2004年1月至2008年12月施行的638例肝移植病人的临床资料。总结原位肝移植术后颅内出血的诊治经过。结果 638例肝移植病人中共发生术后颅内出血10例(1.6%);其中发生于移植术后1周内1例,2周内3例,2周至1个月6例。10例病人一经确诊,均立即采取脱水降低颅内压治疗,并应用抗生素控制感染,其中有4例病人急诊施行了开颅血肿清除术。10例中死亡6例,与术后颅内出血相关的病死率为60.0%。结论肝移植术后颅内出血发病凶险、病死率高。应掌握术后颅内出血的常见原因,对术后意识和精神状态发生改变者要及时进行头颅CT检查,一旦发生颅内出血应积极抢救,及时做出正确的治疗选择,必要时施行开颅血肿清除术。Objective To investigate the clinical features and prophylactico-therapeutic measures of intracranial hemorrhage after orthotopic liver transplantation （OLT）. Methods The clinical data of 638 patients after OUF between January 2004 and December 2008 at the First Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively. The accumulated experiences in diagnosis and treatment of postoperative intracranial hemorrhage after OLT were reviewed. Results Among the 638 patients, 10 patients （1.6%） suffered from intracrania] hemorrhage. One patient happened within the first week afler transplantation, 3 within 2 weeks, 6 within 4 weeks. Once the diagnosis is confirmed, dehydrative measures were taken immediately to decrease the intracranial pressure, and antibiotics were applied to control infection at the same time. Four patients underwent emergency craniotomy to clear the intracranial hematnma. Among 10 patients, 6 patients （60.0%） died. Conclusion Intraeranial hemorrhage after OLT is extremely dangerous with high mortality. Common causes of postoperative intracranial hemorrhage should be well known. Once the patients show any sign of abnormal consciousness, craniocerebral CT should be done immediately and appropriate treatments should be applied. Craniotomy should be performed to clear the hematoma when needed.

关 键 词：肝移植 手术后并发症 颅内出血 

分 类 号：R6[医药卫生—外科学]