南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (08): 950-952.

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原位肝移植术后并发症18例临床分析

苏树英, 陈焕伟, 甄作均, 许卓明, 计勇   

  1. 佛山市第一人民医院肝胆外科, 广东, 佛山, 528000
  • 出版日期:2004-08-20 发布日期:2004-08-20
  • 基金资助:
    收稿日期:2004-1-3。
    基金项目:广东省卫生厅医学科研基金(A2000729)
    作者简介:苏树英(1962-),男,1985年毕业于广东医学院,副主任医师,电话:0757-83833633-1113

Postoperative complications after orthotopic liver transplantation: clinical analysis of 18 cases

SU Shu-ying, CHEN Huan-wei, ZHEN Zuo-jun, XU Zhuo-ming, JI Yong   

  1. 佛山市第一人民医院肝胆外科, 广东, 佛山, 528000
  • Online:2004-08-20 Published:2004-08-20

摘要: 目的 探讨原位肝移植术后并发症的诊治经验。方法 回顾性分析我院18例次原位肝移植(其中2例再次肝移植)病人术后各种并发症的诊治经过。结果 对16例患者(5例终末期肝硬化、7例原发性肝癌、1例肝癌术后肝功能衰竭、1例肝豆状核变性、1例慢性肾功能衰竭合并肝炎后肝硬化、1例急性暴发性肝功能衰竭)进行原位肝移植。手术成功12例,术后最长存活已超过4年。术后并发症包括腹腔内出血3例、脑血管病变2例、肺部感染6例、急性呼吸窘迫综合征(ARDS)2例、肝上下腔静脉狭窄2例、肝动脉血栓形成1例、胆道结石或胆泥3例、胆漏1例、急性排斥反应2例、慢性排斥反应2例、急性肾功能衰竭2例。围手术期死亡6例,直接死亡原因脑出血1例、ARDS1例、急性肾功能衰竭1例、肝动脉血栓1例、急性排斥反应1例、肝功能衰竭1例。结论 肝移植围手术期采取合理的防治措施能有效减少肝移植术后并发症的发生,对肝移植术后并发症的及时诊断和正确处理是提高肝移植成功率的关键。

Abstract: Objective To investigate experience in diagnosis and treatment of postoperative complications in patients under- going orthotopic liver transplantation (OLT). Methods Complications, treatment and management following liver transplantation in 16 cases were analyzed retrospectively. Results Of 16 patients, 5 patients had advanced liver cirrhosis, 7 primary liver carcinoma, 1 liver failure after hepatectomy for liver cancer, 1 Wilson’s disease, 1 chronic renal failure and liver cirrhosis and 1 acute live failure. Twelve patients survived, the longest survival was 4 years. Complications following OLT included: intra-abdominal bleeding in 3 cases, intracerebral vascular lesions in 2, pulmonary infection in 6, adult respiratory distress syndrome in 2, suprahepatic inferior vena caval occlusion in 2, hepatic artery thrombus in 1 case, bile duct stone or sludge in 3, bile leakage in 1 case, acute rejection in 2, chronic rejection in 2, acute renal failure in 2. Six patients died during perioperative period, one patient died of intracerebral bleeding, one from adult respiratory distress syndrome, one of acute renal failureone of hepatic artery thrombus, one of acute rejection and one of liver failure. Conclusions Proper prevention and treatment can effectively reduce complications following OLT during perioperative period. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

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