肝移植术后神经系统并发症28例分析

Neurological complications after liver transplantation: report of 28 cases

目的探讨肝移植术后神经系统并发症的种类、发病率及其相关因素。方法回顾性分析166例原位肝移植患者的临床资料,统计其中神经系统并发症种类及发生率。将患者按照有无神经系统并发症分为A组(有神经系统并发症)和B组(无神经系统并发症),分析神经系统并发症与性别、年龄、原发疾病、移植手术方式、手术时间、无肝期时间、供肝冷缺血时间、手术出血量、红细胞悬液输注量及手术后免疫抑制方案等因素的关系。结果166例肝移植受者发生神经系统并发症28例(32例次),发生率为16.9%;神经系统并发症种类包括脑病、癫痫、脑出血、中枢神经系统感染、严重锥体外系症状及周围神经病变;A、B两组患者在性别、年龄、移植手术方式、手术时间、无肝期时间、供肝冷缺血时间、手术出血量、红细胞悬液输注量及术后免疫抑制方案等方面相比较,差异无统计学意义。神经系统并发症与原发病密切相关,药物性肝功能衰竭患者神经系统并发症发生率高达30%,其中发生脑病的患者达15%;乙型肝炎后肝硬化患者的发生率为21%;原发性胆汁性肝硬化、肝细胞癌及Wilson病的发病率相近,分别为12.5%、16.7%和17.8%,肝细胞癌患者的周围神经病变发生率达10%。结论肝移植后神经系统并发症种类多,发生率高。神经系统并发症与原发疾病有重要关联,应引起临床重视。

Objective To study the classification, its incidence and some related factors of neurological complications after liver transplantation. Methods 166 cases of orthotopic liver transplantation were retrospectively studied. The classification and the incidence of the neurological complications were analyzed. In addition, the patients were divided into two groups, according to whether they suffered from neurological complications or not, to study the difference of related factors, which included gender, age, primary disease, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen. Results Neurological complications occurred in 28 cases （32 times）, which included encephalopathy, seizure, stroke, infection of central nervous system, serious para-pyramidal syndrome and peripheral neuropathy. The total incidence was 16.9 %. Between the neurological complication group and non-neurological-complication group, no difference was found in gender, age, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen, but the neurological complications were closely related with primary diseases. The incidence of neuro- logical complications was 30% in acute liver failure, followed by post-hepatitis B liver cirrhosis （21%）, primary liver carcinoma （17. 8 %）, Wilson disease （16. 7 %） and primary biliary liver cirrhosis （12.5%）. Interestingly as a sole complication disease, the incidence of encephalopathy in acute liver failure was 15 %, that was much higher than that in other primary disease. So was the peripheral neuropathy, which was 10 % in primary liver carcinoma. Conclusions The neurological complication is a kind of serious disease with high incidence after liver transplantation. Its onset may have some relationships with the primary liver disease.