摘要
AIM： To describe cases of gut perforation after orthotopic liver transplantation.METHODS： Data were colleted from our center database and medical records. Six of 187 patients （3.2%）who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation.All patients were male with an average age of 46 years.Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University.RESULTS： Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min （range 45-72 min）,median cold ischaemia time was 11.3 h （range 7-15 h）.Median intraoperative blood loss was 500 mL （range 100-1200 mL） and median operation time was 8.8 h （range 6-12 h）. None of the six patients developed acute cellular rejection. White cell count was above 18 × 10^9/L in five patients （neutrophilic leukocytes were above 90%） and 1.5 × 10^9/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation.CONCLUSION： Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis,preferably through detection of enterococci may ensure better survival.
瞄准：在常位的肝移植以后描述内脏穿孔的盒子。方法：数据是从我们的中心数据库和医药记录的 colleted。从 1 月经历了常位的肝移植到 2005 年 12 月的 187 个病人(3.2%) 中的六个开发了内脏穿孔。所有病人与 46 年的平均年龄是男性的。修改的骑在背肩上的肝移植在机关移植中心被执行，首先隶属于的医院，孙中山大学。结果：静脉的生气 clamp 时间，差的营养的地位和因医生之治疗而引的损害被发现是它的生态的因素的以前的操作，类固醇治疗，和延长的门。有内脏穿孔的病人被发现有发烧，增加的白血球，温和腹的疼痛和温柔。中部的门静脉的 clamp 时间是 63 min (范围 45-72 min ) ，中部的冷 ischaemia 时间是 11.3 h (范围 7-15 h ) 。中部的 intraoperative 失血是 500 mL (范围 100-1200 mL ) ，中部的操作时间是 8.8 h (范围 6-12 h ) 。任何一个都没六个病人开发尖锐细胞的拒绝。白房间计数多样地超过 18 是在五个病人的 109/L (嗜中性白血球超过 90%) 并且 1.5 在一个病人乘 109/L。在排水液体的细菌的文化在五个病人揭示了 enterococci。经历常位的肝移植的 6 个病人， 3 在修改的骑在背肩上的肝移植以后幸存， 3 死了。结论：内脏穿孔在成年人发生在常位的肝移植以后。小心、最小的解剖在 OLT 期间，胃试管的更长的保留，并且减少门 clamp 时间和类固醇剂量应该被考虑。如果内脏穿孔是没阻止的、那么早的诊断，可以最好通过 enterococci 的察觉保证更好的幸存。
