原位肝移植术后近期并发症的防治  

THE PROPHYLAXES AND TREATMENT OF POSTOPERATIVE COMPLICATIONS IN ORTHOTOPIC LIVER TRANSPLANTATION

作　　者：严律南[1] 李波[1] 卢实春[1] 文天夫[1] 曾勇[1] 赵继春[1] 程南生[1] 

机构地区：[1]四川大学华西医院普外科,四川成都610041

出　　处：《实用临床医药杂志》2003年第1期33-36,共4页Journal of Clinical Medicine in Practice

摘　　要：目的　探讨原位肝移植术后并发症发生的常见原因及预防与处理措施。方法　回顾性分析近 3年来所施行的 72例原位肝移植病人术后并发症发生的种类及数量 ,以及诊治处理方法 ,以探讨成功及失败原因。结果　 72例肝移植病人中 ,原发病为良性疾病 5 0例 (其中终末期乙型肝炎肝硬变 3 4例 ) ;恶性疾病 2 2例 (其中HCC 19例 )。术后发生并发症 5 4例次 ,其中因凝血功能紊乱致术后腹腔内继发性出血 4例 ,术前腹水感染未能控制 ,致术后腹水严重感染 2例 ,激素用量过大致应激性溃疡出血、穿孔 1例 ,胆瘘 6例 ,肺部感染 2 1例 ,肠道霉菌感染 5例。全组无原发性肝无功能及血管并发症 ,随访 2～ 41个月 ,无远期胆道并发症及慢排发生。住院期死亡 6例 ,随访期死亡 6例 ,目前生存 60例 ,总生存率为 83 3 3 % ,存活超过 1年者 3 2例 ,最长已达 3年 5月。结论　我国肝移植患者适应证以终末期乙肝肝硬化为主 ,这类病人肝功能不良 ,凝血功能障碍 ,围手术期凝血功能的纠正甚为重要 ,同时这类病人多存在营养不良 ,免疫功能低下 ,应重视围手术期感染的控制及营养支持。手术技术的完善是预防肝移植后血管并发症的关键。Objective: To investigate the common reasons, prophylaxes and treatment of postoperative complications in orthotopic liver transplantation(OLT). Methods: 72 patients who underwent OLT during recent 3 years were collected and analyzed retrospectively. Results: OLT was performed on 50 cases with benign diseases including terminal liver cirrhosis 34, and 22 cases with and malignant diseases including hepato cellular carcinoma 19 cases. 54 complications were occurred postoperatively, including secondary abdominal cavity bleeding (4 cases), severe infection of ascites (2 cases), stress gastric ulcer with bleeding and perforation (1 case), biliary leak (6 cases), pulmonary infection (21 cases),and enteric fungal infection (5 cases). There were no primary dysfunction of liver and vascular complications. Follow up 2～41 months, without biliary complications and chronic liver dysfunction occurred. 6 cases death postoperative, 6 cases death on follow-up period. Total surrival rate is 83 33%, 32cases alive more than 1 year and the longest surrival cases is 41 months postoperative. Conclusions: It is suggested that the cases with cirrhosis are main indication for liver transplantation. The patients with liver cirrhosis are always combinated with liver disfunction, coagulopaphy, malnutrition and poor immune functions and we should pay attention to replace that of coagulation factors, antibiotics using and nutrition support perioperatively. Good surgical technique is the key point for preventing vascular complications.

关 键 词：手术后并发症 原位肝移植术 防治 围手术期 肺部感染 腹腔出血 肾衰竭 

分 类 号：R657.3[医药卫生—外科学]