肝移植术后肝脓肿的诊治体会(附8例报道)  

Diagnosis and Treatment Experience of Liver Abscess after Liver Transplantation:A Report of 8 Cases

作　　者：熊日晖 蔡秋程[1] 丁晨[1] 李嵩[1] 潘凡[1] 张坤[1] 张小进[1] 江艺[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福建福州350001

出　　处：《中国普外基础与临床杂志》2014年第12期1531-1536,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：福建省自然科学基金重点项目(项目编号:2011Y0046);军区医学科技创新重点课题(项目编号:11Z033)~~

摘　　要：目的探讨肝移植术后肝脓肿的临床特点和治疗手段,以改善其预后。方法回顾性分析笔者所在医院1999年4月到2013年9月期间收治的8例肝移植术后肝脓肿病例的临床资料,总结其临床特点、诱发因素、治疗方法及预后转归。结果 387肝移植患者术后发生肝脓肿8例,发生率为2.07%,主要诱因为各种胆道并发症、肝动脉并发症等。其主要的治疗方法包括使用敏感抗生素、减少或停用免疫抑制剂、超声引导下的脓肿穿刺引流、胆管狭窄球囊扩张成形术、经皮肝穿刺胆道引流术（PTCD）、留置胆管支架、经内镜鼻胆管引流术（ENBD）及肝病灶切除术。8例患者均获访,随访时间3-59个月,中位数为23个月;其中4例治愈,1例好转,3例死亡。结论肝动脉和胆道并发症是肝移植术后肝脓肿发生的重要诱因,积极预防、治疗胆道和肝动脉并发症是减少肝移植术后肝脓肿发生和改善其预后的关键。Objective To investigate the clinical characteristics and treatment to improve the prognosis of liver abscess after liver transplantation. Methods Eight cases of liver abscess after liver transplantation who were treated in our hospital from Apr. 1999 to Sep. 2013 were retrospectively analyzed, including clinical presentation, predisposing factors, treatment, and prognosis of outcomes. Results In our group, the incidence of liver abscess after liver transplantation was 2.07% （8/387）, and main predisposing factors included biliary complications, hepatic artery complications, and so on. The treatments included sensitive antibiotics therapy, reducing or deactivating immunosuppressant, aspiration and drainage of abscess by the ultrasound guiding, balloon valvuloplasty for biliary stenosis, percutaneous transhepatic cholangial drainage （PTCD）, indwelling biliary stents, endoscopic nasobiliary drainage （ENBD）, and hepatic resection. All of the 8 cases were followed-up for 3-59 months （median of 23 months）, during the follow-up period, 4 cases were cured, 1 case improved, and 3 cases died. Conclusions Hepatic arterial and biliary complications are the most common predisposing factors for liver abscess after liver transplantation. Active prevention and treatment of biliary and hepatic arterial complications after liver transplantation are the key to reduce the occurrence of liver abscess and improve the prognosis of it.

关 键 词：肝脓肿 肝移植 肝动脉血栓形成 肝动脉狭窄 胆道并发症 

分 类 号：R657.3[医药卫生—外科学] R619[医药卫生—临床医学]