小儿肝移植术后肠梗阻病因鉴别及预后分析  

Differentiation and prognosis of intestinal obstruction after pediatric liver transplantation.

作　　者：单禹华 顾松[1] 徐敏[1] 褚珺[1] 胡明[1] 陈盛[1] 陈其民[1] 严志龙[1] Shan Yuhua;Gu Song;Xu Min;Chu Jun;Hu Ming;Chen Sheng;Chen Qimin;Yan Zhilong(Department of Surgery,Affiliated Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China.)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心,上海市200127

出　　处：《临床小儿外科杂志》2021年第6期576-581,587,共7页Journal of Clinical Pediatric Surgery

基　　金：上海市抗癌协会雏鹰计划(编号:SACA—CY20C11)。

摘　　要：目的分析儿童肝移植术后肠梗阻的原因及预后,探讨肠梗阻病因的提示性因素。方法对上海交通大学医学院附属上海儿童医学中心2013—2018年接诊的30例儿童肝移植术后肠梗阻患者的临床资料进行回顾性分析。结果肝移植术后肠梗阻病因包括:移植后淋巴增生异常(posttransplant lymphoproliferative disorder,PTLD)8例,医源性胃肠道穿孔5例,粘连性肠梗阻10例,膈疝2例,自发性腹膜炎5例。30例中15例接受剖腹探查手术。总体生存率73.33%,死亡8例,其中PTLD 4例,医源性胃肠道穿孔3例,自发性腹膜炎1例;距离肝移植术平均时长PTLD为(13.4±10.5)个月,粘连性肠梗阻为(3.14±3.18)个月,自发性腹膜炎为(6.00±6.16)d;医源性胃肠道穿孔为(8.00±4.18)d。通过发病病因时间来预测术后3个月以内和3个月以后发生的肠梗阻:受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)为1.000(P<0.0001);通过发病时间预测PTLD和粘连性肠梗阻的AUC为0.856(P=0.011)。结论PTLD和胃肠道穿孔是肝移植术后肠梗阻最常见原因,也是重要的致死原因,不同的发生时间对于病因有一定提示作用。Objective To explore the cause and prognosis of intestinal obstruction after liver transplantation(LT)in children and explore the suggestive factors of etiology.Methods A retrospective analysis was performed for 30 children hospitalized with intestinal obstruction after LT from 2013 to 2018.Results The etiologies included posttransplant lymphoproliferative disorder(PTLD,n=8),gastrointestinal perforation due to surgical trauma(n=5),adhesive intestinal obstruction(n=10),diaphragmatic hernia(n=2)and spontaneous peritonitis(n=5).Fifteen children underwent exploratory laparotomy.The overall survival rate was 73.33%.The causes of death were PTLD(n=4),severe infection after perforation(n=3)and spontaneous peritonitis caused by systematic infection(n=1).The average occurring time was(13.4±10.5)months after LT for PTLD,(3.14±3.18)months for adhesive intestinal obstruction,(6.00±6.16)days for spontaneous peritonitis and(8.00±4.18)days for perforation.The cause of posttransplant intestinal obstruction occurring within 3 months or not could be predicted by receiver operating characteristic(ROC)curve of onset time and the area under curve(AUC)was 1.000(P<0.0001);PTLD and adhesive intestinal obstruction could be differentiated by onset time and AUC was 0.856(P=0.011).Conclusion PTLD and perforation are important causes of death.And different occurring times may hint at the cause.

关 键 词：肝移植/方法 手术后并发症 肠梗阻 移植后淋巴增生异常 肠穿孔 

分 类 号：R617[医药卫生—外科学] R725.742[医药卫生—临床医学]