肝移植术后高胆红素血症的鉴别诊断  

Differential diagnosis of bilirubinemia after liver transplantation

作　　者：陈大志[1] 陈嘉薇[2] 邰升[1] 迟强[1] 孙世波[1] 胡占良[1] 张新宇[1] 韩德恩[1] 陈昭民[1] 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,哈尔滨市150086 [2]哈尔滨医科大学附属第二医院病理科,哈尔滨市150086

出　　处：《中华肝胆外科杂志》2001年第8期466-468,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝移植术后高胆红素血症的发生规律和特点,提高鉴别诊断和治疗的正确率。方法总结5例肝移植术后高胆红素血症的发生频度、诊断和治疗效果,分析导致高胆红素血症的各种可能因素,提出鉴别诊断的要点。结果5例肝移植共经历了11次高胆红素血症,其中急性排斥反应3例,肝内胆汁淤滞2例,胆总管内支撑物堵塞、csA 毒性反应以及肝动脉血栓形成各1例,均及时诊断并治愈。肝外胆道进行性狭窄、慢性排斥反应、供肝原发性无功能、以及乙肝复发各1例次,由于未能及时诊断导致治疗失败。结论高胆红素血症是肝移植术后常见并发症,原因和机理错综复杂。了解肝移植术后恢复过程的规律,根据胆红素升高的时间,辅助检查结果以及病理学所见及时作出正确诊断,是治疗成功的关键。Objective To investigate the occurring rule and characteristics of bilirubinemia after liver transplantation to improve proper rate of differential diagnosis and treatment.Methods The frequency of occur- rence,diagnoses and the effect of treatment were retrospectively studied in 5 cases of liver transplantation with the complication of bilirubinemia.The factors inducing the bilirubinemia were analyzed and the key points of differen- tial diagnosis posed.Results Five patients experienced 11 times of bilirubinemia including 3 cases of acute rejec- tion,2 cases of intrahepatic cholestases,1 case ofT tube obstruction and 1 case of CsA toxicity.All the patients were cured with timely diagnosis and treatment.However,the treatments failed for progressive stricture in extro- hepatic bile duct,chronic rejection,primary nonfunction in donor liver and the recurrence of HBV because the di- agnoses were not made in time.Conclusions Bilirubinemia is a common complication after liver transplantation and its reasons and mechanism are complicated.The key point for successful treatment is to study the recovery pro- cess after the liver transplantation and to have a proper diagnosis according to the raising time of bilirubin,results of supplementary examinations and pathological findings.

关 键 词：肝移植 并发症 高胆红素血症 鉴别诊断 

分 类 号：R657.3[医药卫生—外科学] R575[医药卫生—临床医学]