肝移植术后腹腔出血的原因与防治

Causes and management of intra-abdominal hemorrhage after orthotopic liver transplantation

目的探讨原位肝移植(OLT)术后腹腔出血的原因和有效的防治措施。方法回顾性分析和总结1999年2月至2004年6月OLT术后13例腹腔出血患者的临床资料。结果腹腔出血发生率为7.2%(13/181),病死率为15.4%(2/13)。出血发生在OLT术后24h内7例(53.8%),7d内9例(69.2%),7d后4例(30.8%)。出血部位包括供肝活检部位渗血3例、腹壁出血3例、肝动脉吻合口出血2例、胆总管吻合口出血2例、腹腔渗血2例和下腔静脉壁的分支出血1例。结论OLT术后近期腹腔出血的主要原因是凝血功能紊乱和术中止血不妥;腹腔感染或胆漏引起血管破裂是致使后期腹腔出血的主要原因。纠正凝血功能紊乱,精细的手术操作和控制腹腔感染或胆漏可有效的预防OLT术后的腹腔出血。

Objective To study the causes of intra- abdominal hemorrhage after orthotopic liver transplantation （OLT） and find out effective measures for prevention and treatment. Methods Clinical data of 13 patients with intro- abdominal hemorrhage undergoing OLT from Feb. 1999 to June 2004 were analyzed retrospectively, Results Platelets of patients before and after OLT was significantly lower than those in the normal controls. Nine cases （69.2 % ） of intra - abdominal hemorrhage occurred in one week post- OLT,8 cases （53.8%） in 24 h and other 4 cases （30.8%） 7 days post - OLT. Areas of intra- abdominal hemorrhage included the place of biopsy in donor liver （ n = 3）, incision （ n = 3） ,hepatic artery （ n = 2） and anastomoses of biliary tract （ n = 2 ）. Incidence and mortality of intra- abdominal hemorrhage was 7.2 % （13/181） and 15.4% （2/13）, respectively. Conclusion The main causes of intra- abdominal hemorrhage in the early stage after OLT are disorder of coagulation function and inadequately perioperatively hemostasis. Intra - abdominal infection or bile leakage- induced rupture of blood vessels was the main causes of intra - abdominal hemorrhage at the late state after OLT. To correct disorder of coagulation function, perform operation carefully and control intra- abdominal infection can effectively prevent intra - abdominal hemorrhage after OLT.