肝移植术后严重胆管损伤并发症行再次肝移植治疗

Liver retranplantation: the role in management of serious biliary complications after liver transplantation

目的探讨肝移植术后发生胆管损伤并发症行再次肝移植治疗的临床经验。方法回顾性分析2002年4月至2004年8月实施的250例次肝移植,其中5例患者因术后出现严重胆管损伤并发症而再次行肝移植。结果5例再次肝移植患者中,3例治愈,已经分别存活5个月、6个月和8个月;2例分别于手术后8d和43d死亡,1例死于肝移植术后肝脏功能丧失,并发肺部感染和心力衰竭,另外1例死于肾功能衰竭。再次肝移植术后并发症有腹腔积液、肝脓肿、胆系感染和肺部感染。结论肝移植术后发生严重胆管损伤并发症行再次肝移植是有效的治疗方法。正确把握适应证和手术时机,手术中精细操作,围手术期严密监测和正确处理,是提高再次肝移植患者存活率的关键。

Objective To explore the clinical experience of liver retransplantation in management of biliary complications after liver transplantation.Methods The clinical data of patients receiving liver transplantion in our department between April 2002 and Aug. 2004 were retrospectively analyzed, including 5 patients being subjected to liver retransplantation because of serious biliary complication.Results Three patients were cured with the survival time being 5 months, 6 months and 8 months respectively. Two patients died at 8th and 43rd day: one died of liver non-function combining with lung infection and heart failure, and another died of renal failure. Complications included liver absess, biliary infection, wound infection, hydrops abdominis and lung infection.Conclusions Liver retransplantation is an effective treatment for serious biliary complications after liver transplantation. Surgical procedure, indication, operative opportunity, perioperative monitoring and so on contribute to the increase of the survival rate of the patients receiving liver retransplantation.