原位肝移植术后早期上消化道出血的诊治  被引量:5

Diagnosis and treatment of upper gastrointestinal hemorrhage after orthotopic liver transplantation

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作  者:李自强 邹卫龙[1] 陈新国[1] 朱雄伟[1] 张勇 Li Ziqiang;Zou Weilong;Chen Xinguo;Zhu Xiongwei;Zhang Yong.(Chinese People's Armed Police Force, Beijing 100080, China)

机构地区:[1]中国人民武装警察部队总医院,北京100080

出  处:《腹部外科》2018年第2期100-103,共4页Journal of Abdominal Surgery

摘  要:目的探讨肝移植术后早期上消化道出血的原因和处理方案。方法回顾性分析2010年1月至2017年7月期间26例肝移植术后上消化道出血病人的临床资料,总结肝移植术后早期上消化道出血的病因以及临床处理经验。结果 797例肝移植病人发生术后上消化道出血者26例(3.2%),其中15例(57.7%)为消化性溃疡;3例(11.5%)为急性胃十二指肠炎;3例(11.5%)为门静脉高压性胃病;3例(11.5%)为胆道出血;1例(3.8%)为胆肠吻合口出血;1例(3.8%)为不明原因出血。治疗方案:内科保守治疗4例(15.4%);内镜下治疗18例(69.2%);血管造影行肝动脉栓塞者3例(11.5%);手术探查者1例(3.8%)。术后随访3~91个月(平均38个月),其中2例经积极的止血治疗无效后死于消化道出血,1例死于肝移植围手术期多器官功能衰竭,2例死于全身多发继发性恶性肿瘤。其他21例经过内科保守治疗、内镜下止血、肝动脉栓塞、手术探查止血等治疗措施后出血停止,并长期存活。结论肝移植术后上消化道出血的发病原因主要为消化道溃疡、急性胃肠黏膜病变及门静脉高压性胃病等,应积极寻找病因并正确选择处理措施。Objective To investigate the causes and treatment of upper gastrointestinal bleeding after liver transplantation.Methods The clinical data of 26 patients with upper gastrointestinal hemorrhage after liver transplantation were analyzed retrospectively,and the etiology and clinical treatment of upper gastrointestinal hemorrhage after liver transplantation were summarized.Results Of 797 cases of liver transplantation,26 cases(3.2%)suffered from the upper gastrointestinal hemorrhage,including 15(57.7%)cases of peptic ulcer,3(11.5%)cases of acute gastroduodenitis,3(11.5%)cases of portal hypertension,3(11.5%)cases of biliary bleeding,1(3.8%)case of hemorrhage of choledochoid,and 1(3.8%)case of bleeding with unknown reasons.For treatment regimen,4 cases(15.4%)were given conservative treatment,18 cases(69.2%)given endoscopic treatment,3 cases(11.5%)given hepatic arterial embolism in angiography(11.5%),and one case(3.8%)given surgical exploration.During follow-up periods of 3-91 months(38 months on average)postoperatively,2 cases died of digestive tract hemorrhage after active hemostatic treatment was invalid,1 case died of perioperative multiple organ failure following liver transplantation,and 2 cases died of multiple secondary malignant tumors.The remaining 21 cases were treated by medical conservative treatment,endoscopic hemostasis,hepatic artery embolization,and surgical exploration for hemostasis.Conclusions The etiology of upper gastrointestinal bleeding after liver transplantation is mainly attributed to the digestive tract ulcer,acute gastric mucosal lesion and portal hypertension gastropathy,etc.We should choose the reasonable treatment measures on the basis of disease reasons.

关 键 词:肝移植 上消化道出血 治疗 

分 类 号:R617[医药卫生—外科学]

 

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