60例肝移植术后高胆红素血症的诊治体会

THE DIAGNOSIS AND TREATMENT OF POSTOPERATIVE HYERBILIRUBINEMIA AFTER LIVER TRANSPLANTATION

目的探索原位肝移植术后高胆红素血症的原因及处理。方法回顾性总结60例同种异体原位肝移植术后高胆红素血症的原因、诊断；提出不同的治疗方法及不足之处。结果术前高胆红素血症、原发病复发为原位肝移植术后高胆红素血症的主要原因。（1）术前高胆红素血症者占90．00％，未作特别处理，术后第1天血总胆红素明显下降，3周内降至正常;（2）原位肝移植术后肝脏缺血再灌注损伤者占95．00％，给予重组人生长激素10^11×14天，术后血总胆红素1周内均逐渐升高，2周年左右达高峰，3周左右下降，1个月内基本正常。（3）急性排斥反应者占15．00％，均采用甲基强的松龙冲击治疗同时提高FK506谷值浓度、增加骁悉。多数患者总胆红素在治疗后第2天开始下降，3个月左右下降至正常；（4）胆道并发症者占11．67％，大部分患者解除胆漏或胆道狭窄后血总胆红素3周左右降至正常；（5）血管并发症导致的高胆红素血症患者占11．6．7％，其中，4例治愈，3例死亡；（6）原发病复发导致高胆红素血症占18．33％，均为肝脏恶性肿瘤复发所致，所有7例患者均在术后4～11个月内死亡。结论高胆红素血症是原位肝移植术后常见的并发症，病因多样而复杂，需根据血总胆红素升高的时间、辅助检查及病理学所见及时作出正确论断，才能达治疗的目的，巩固肝移植的成果。

Objictive To explore the cause and treatment of postoperative hyperhiliruhinemia after orthotopic live transplantation. Methods Study the cause and diagnosis of 60 cases postoperative hyperbilirubinemia after orthotopie liver transplantation retrospectively and present different treatments and disadvantages. Repults The main causes of postoperative hyperbilirubinemia after orthotopic liver transplantation are preoperative hyperbilirubinemia, ischemia-reperfusion injury, acute rejection, biliary and vessel complications and the recurrence of primary disease. （1）90, 00% is preoperative hyperbilirubinemia, which were not treated specially. Total bilirubin（TBIL） of bolld decreased singificantly on the first day of postoperation and restored to normal level in 3 weeks. （2）Ischemia reperfusion injury of liver accouted 95.00% of postoeration. The level of TBIL increased gradually in 1 week and reached to chimax on 2 weeks or so of postoperation. It decreased on 3 weeks, to normal in 1 month. （3）Acute rejection accounted 15.00% ,which were treated with methylprednisolone,accompanying with elevated Co of tacrolimus and amount of mycophenolate mofetil. The TBIL of most patients started to decrease on the second day and restored to normal level on 3 months after the treatment. （4）Billary complication accounted 11.67 %, the level of TBIL decreased to nor-mal on 3 weeks after most patients were cured of biliary leak and stenosis of biliary tract. （5）Vessel complications,which leaded to hyperbilirubinemia, accounted 11.67%, of which 4 cases were cured and 3 cases died. （6）The cases of recurrence of primary disease were 7,which accounted 18.33%. All of them were the recurrence of liver malignant tumor and died in 4-11 months postoperation. Conclusion Hyperbilirubinemia is a common complication of postoperative orthotopic liver transplantation and is causes are multiplicity. In order tO reach the aim of treatment and reinforce the effect of liver transplantationit needed to diagnose correctly according to the time of increase of the TBIL,data of auxiliary examination and changes of pathology.