同种原位肝移植术后并发症的防治体会  

Prevention and treatment of postoperative complications in orthotopic liver transplantation

作　　者：严律南[1] 李波[1] 卢实春[1] 金立人[1] 文天夫[1] 伍晓汀[1] 贾乾斌[1] 周涌[1] 吴言涛[1] 

机构地区：[1]华西医科大学附属第一医院普外科,成都市610041

出　　处：《中华肝胆外科杂志》2001年第8期462-465,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨同种原位肝移植术后并发症发生的常见原因与预防及处理措施。方法回顾性分析我科近一年来所施行的18例原位肝移植病人术后并发症发生的种类及数量,以及诊治处理方法,以探讨成功及失败原因。结果 18例肝移植病人中,原发病为终末期乙肝肝硬变13例,先天性弥漫性肝内胆管囊性扩张2例,布-加氏综合征1例,原发性肝癌2例。术后发生并发症15例次,含因凝血功能紊乱致术后腹腔内继发性出血3例,术前腹水感染未能控制致术后腹水严重感染1例,激素用量过大致应激性溃疡出血、穿孔1例,胆瘘1例,肺部感染4例,口腔弥漫性溃疡3例,肠道霉菌感染2例。手术死亡3例,分别为肺部曲霉菌感染,应激性溃疡穿孔及腹水感染所致。术后5个月因肝癌复发死亡1例,现仍存活14例,4例已存活1年以上。结论我国肝移植病人适应证以终末期乙肝肝硬化为主,这类病人肝功不良,凝血障碍,围手术期凝血功能的纠正甚为重要,同时这类病人多存在营养不良,免疫功能低下,应重视围手术期感染的控制及营养支持。手术技术的完善是预防肝移植后血管并发症的关键。Objective To investigate the common reasons and prevention and treatment of postoperative complications in orthotopic liver transplantation(OLT).Methods Data of 18 patients undergoing OLT in recent 1 year were collected and retrospectively analyzed.Results OLT was performed in 13 patients with terminal liver cirrhosis,2 with Caroli's disease,1 with Budd-Chairi's syndrome and 2 with primary liver cancer.A total of 15 cases times of complications occurred postoperatively,including secondary abdominal cavity bleeding(n=3),se- vere infection of ascites(n=1),stress gastie ulcer with bleeding and perforation(n=1),biliary fistula(n=1), pulmonary infection(n=4),diffuse oral ulcer(n=3)and fungal infection(n=2).Three patients died postoper- atively from pulmonary fungal infection,stress ulcer and ascites infection,respectively.Another patient died of re- currence of liver cancer 5 months after the operation.The other 14 patients are still alive and 3 of them have sur- vived for over 1 year.Conclusion Liver cirrhosis is the main indication for liver transplantation.The patients with liver cirrhosis usually exhibit liver disfunction,coagulopathy,malnutrition and poor immune functions.It is impor- tant to pay close attention to periopetafive improvement of coagulative capacity,control of infections and support of nutrition in these patients.Good surgical technique is the key factor for preventing vascular complications.

关 键 词：肝移植 肝硬变 并发症 围手术期 同种原位移植 

分 类 号：R657.3[医药卫生—外科学]