肝移植术后肝动脉假性动脉瘤破裂三例分析  

Rupture of hepatic artery pseudoaneurysm after liver transplantation:a report of three patients

作　　者：谢占涛[1] 赵会博 王维伟[1] 袁振华 陈永峰[1] 孙建军[1] 魏思东[1] 陈国勇[1] Xie Zhantao;Zhao Huibo;Wang Weiwei;Yuan Zhenhua;Chen Yongfeng;Sun Jianjun;Wei Sidong;Chen Guoyong(Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院肝胆胰腺外科,郑州450003

出　　处：《中华肝胆外科杂志》2020年第3期180-182,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省医学科技攻关计划(SBGJ2018071)。

摘　　要：目的探讨肝移植术后肝动脉假性动脉瘤破裂的发生、诊断及治疗。方法收集2010年4月至2019年4月河南省人民医院肝胆胰腺外科肝移植受者资料,筛选出发生肝动脉假性动脉瘤破裂3例,均为男性,年龄41~57岁。分析其发生原因、临床表现、诊断及治疗。结果肝动脉假性动脉瘤破裂时间分别为术后第19天、28天、63天。3例患者均有便血、腹痛,2例伴呕血,2例胆漏伴腹腔感染。3例患者术后均有发热。病例1经剖腹探查肝动脉结扎后因肝功能衰竭死亡,病例2行肝动脉介入栓塞后因肝功能衰竭死亡,病例3手术切除假性动脉瘤并行肝动脉重建,反复腹腔大出血。结论肝移植术后肝动脉假性动脉瘤发生时间跨度大,早期不易诊断,病情进展迅速,预后差,需重点防治胆漏、腹腔感染等。Objective To report on 3 patients who presented with rupture of hepatic artery pseudoaneurysm after liver transplantation.Methods From April 2010 to April 2019,3 patients with hepatic artery pseudoaneurysm rupture after liver transplantation treated at the Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital were studied.The possible causes,clinical manifestations,diagnosis and treatment were retrospectively analyzed.Results Rupture of hepatic artery pseudoaneurysm occurred on the19th,28th and 63th days after transplantation.The 3 patients all presented with hematochezia and abdominal pain,while 2 patients presented with hematemesis.Two patients had bile leakage and abdominal infection.All the 3 patients presented with fever.Patient 1 who was diagnosed by laparotomy died of liver failure.Patient 2 underwent interventional embolization of hepatic artery and died of liver failure also.Patient 3 underwent surgical resection of the pseudoaneurysm followed by hepatic artery reconstruction,but died of repeat abdominal hemorrhage.Conclusion Hepatic artery pseudoaneurysm after liver transplantation has a long latent period and is difficult to diagnose at an early stage.Early detection of this life-threatening complication is the key to improve survival.Early treatment of biliary leakage,abdominal infection and other complications help to prevent development of pseudoaneurysms.

关 键 词：肝移植 假性动脉瘤 腹腔感染 

分 类 号：R657[医药卫生—外科学]