心脏死亡供肝肝移植术后并发移植肝大范围坏死分析  

Extensive Liver Necrosis after Donation after Cardiac Death Liver Transplantation

作　　者：王少发 陈知水[1,2] 张万广[3] 董汉华[3] 魏来 蒋继贫[1] 王怀宇 腾浩 程琪 胡朝华 赵琳 张必翔 陈孝平[1,2] Wang Shaofa Chen Zhishui Zhang Wanguang et al(Institute of Organ Transplantation 3Liver Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology ,Wuhan 430030, Chin 2Key Laboratory of Organ Transplantation ,Ministry of Health and Ministry of Education ,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所 [2]华中科技大学同济医学院附属同济医院教育部/卫生计生委器官移植重点实验室 [3]华中科技大学同济医学院附属同济医院肝脏外科 [4]中国人民解放军96763部队医院 [5]湖北医药学院药护学院

出　　处：《华中科技大学学报（医学版）》2017年第5期579-582,592,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家卫生计生委卫生行业科研专项项目(No.201302009);国家自然科学基金资助项目(No.81373168);国家重点基础研究发展计划子课题(No.2013CB530803)

摘　　要：目的探讨心脏死亡供肝肝移植术后的并发症和应对措施。方法回顾分析同济医院2013年12月至2015年11月期间的24例心脏死亡供肝肝移植病例资料,观察患者术后的恢复情况,并总结对术后并发症的治疗原则。结果术后谷草转氨酶和谷丙转氨酶峰值的均值分别为1 951U/L和962U/L。患者住院时间(22±5)d(10~35d)。住院期间共发生常规术后并发症6例(25.0%),死亡1例(4.2%),无原发性无功能发生,但是术后1周的增强CT检查发现了一种新的并发症——移植肝大范围坏死,共4例(16.7%)。对肝坏死患者采取保证肝脏灌注、减轻炎症反应、避免药物肝毒性和预防肝坏死后感染的治疗原则,术后20~28d复查CT示移植肝坏死灶已修复或消失。结论心脏死亡供肝损伤较严重时,容易发生移植肝大范围坏死。在正确诊断和积极治疗的基础上,移植肝坏死是可能完全修复的,由此可能部分降低原发性无功能的发生。Objective To explore the postoperative complications after donation after cardiac death liver transplantation and the treatment strategies.Methods We retrospectively analyzed early-stage 24 recipients who had liver transplant from the cardiac death donors and observed the occurrence of postoperative complications and patients＇ responses to treatment protocols.Results Postoperative peak values of aspartate transaminase and alanine transaminase were 1951U/L and 962U/L respectively.The length of stay in hospital was 22±5 days（10-35days）.During the hospitalization,there were 6 patients（25%）developing common postoperative complications,resulting in one death（4.2%）.No primary nonfunction was found.However,within one week after the transplantation,enhanced CT showed a new complication-extensive liver necrosis in 4 patients（16.7%）.Treatment protocols for liver necrosis included securing the liver perfusion,reducing secondary inflammatory response,avoiding drug hepatotoxicity and preventing secondary infection after liver necrosis.The necrotic lesion of the liver grafts fully recovered 20 to 28 days after the transplantation.Conclusion Liver grafts with relatively severe injury from cardiac death donors are susceptible to extensive liver necrosis after transplantation.On the basis of correct diagnosis and agressive treatment,necrotic lesion in liver grafts is likely to be completely repaired,which may partially reduce the occurrence of primary nonfunction.

关 键 词：肝移植 心脏死亡供体 术后并发症 肝坏死 增强CT 

分 类 号：R617[医药卫生—外科学]