儿童肝移植20例诊治分析  

Diagnoses and treatments of hepatic transplantation in 20 children

作　　者：彭宇明 司中州[2] 袁妙贤[1] 陈立健[1] 盛新仪 谢惟心 吴秀婷[1] 尹强[1] Peng Yuming;Si Zhongzhou;Yuan Miaoxian;Chen Lijian;Sheng Xinyi;Xie Weixin;Wu Xiuting;Yin Qiang(Department I of General Surgery,Hunan Children's Hospital,Changsha 410007,China;Division of Organ Transplantation,Department of General Surgery,Second Xiangya Hospital,Central South University,Changsha 410007,China.)

机构地区：[1]湖南省儿童医院普外一科,湖南省长沙市410007 [2]中南大学湘雅二医院普外器官移植科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2019年第8期681-685,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生健康委员会技术创新项目(编号:湘卫医政医管处便函[2018]187号)

摘　　要：目的回顾性分析20例肝移植患儿的临床资料,旨在总结儿童肝移植的临床诊治经验。方法回顾性分析2017年5月至2019年6月湖南省儿童医院联合中南大学湘雅附二医院对20例儿童实施肝脏移植手术的临床资料,原发疾病主要包括胆道闭锁、Alagille综合征、先天性肝内门静脉海绵样变性。手术方式采用亲体部分肝移植手术(n=16)和儿童心脏死亡器官捐献(donation after cardiac death,DCD)肝脏移植手术(n=4)。20例均应用他克莫司联合激素免疫抑制方案,其中3例增加了吗替麦考酚酯联合抗排斥反应。术后患儿给予抗感染、抗排斥等对症支持治疗,密切监测肝血管吻合处血流情况及肝功能变化,观察术后并发症及预后。结果 20例患儿均移植成功,肝移植供体均康复出院,无并发症发生。受体术后早期主要并发症为感染,以细菌感染为主,感染部位为肺部和腹腔。术后1例出现肝动脉栓塞,3例出现乳糜漏,2例出现胆道狭窄,3例出现早期排斥反应,1例出现消化道大出血,经对症治疗均痊愈出院,检测肝功能及血药浓度均在正常范围。结论儿童终末期肝病可通过活体肝移植或DCD肝移植手术取得理想的效果,手术方式可根据患儿的年龄、体重进行选择。Objective To explore the clinical efficacies and treatments of 20 pediatric cases of hepatic transplantation. Methods From May 2017 to June 2019,retrospective analysis was performed for the clinical data of 20 cases of pediatric hepatic transplantation at Hunan Children s Hospital and Second Xiangya Hospital,Central South University.The primary diseases included biliary atresia,Alagille syndrome and congenital intrahepatic cavernous transformation of portal vein.The surgical approaches were parental partial hepatic transplantation ( n =16) and DCD hepatic transplantation ( n =4).Tacrolimus plus hormonal immunosuppression were applied and three cases received additional mycophenolate mofetil.Antibiotic agents and anti-rejection supports were employed postoperatively.Blood flow in the anastomosis of hepatic vessels,liver function alterations,postoperative complications and prognosis were recorded. Results All recipients were successfully operated and all donors had no complications.The early major complications of recipients was predominantly bacterial infection and the infection sites included lung and abdominal cavity.The postoperative complications were hepatoarterial embolization ( n =1),chylous fistula ( n =3),biliary stricture ( n =2),early rejection ( n =3) and massive hemorrhage of gastrointestinal tract ( n =1).After symptomatic treatments,all recipients recovered and were discharged.Both liver function and blood drug concentrations were within normal ranges. Conclusion Advanced liver disease in children may be ideally treated by living or DCD hepatic transplantation.And surgical approach is selected on the basis of age and body weight.

关 键 词：肝移植 胆道闭锁/外科学 肝硬化/外科学 适应证 手术后并发症 儿童 

分 类 号：R617[医药卫生—外科学] R657.3[医药卫生—临床医学]