原位肝移植联合胰十二指肠根治性切除术治疗肝门部胆管癌患者并发症的观察及护理

Observation and nursing for patients with complications of carcinoma of bile duct in hepatic porta cured by hepatectomy pancreaticoduodenectomy with orthopic liver transplantation

目的探讨原位肝移植联合胰十二指肠根治性切除（HPLT）术后患者早期并发症的观察及护理要点。方法回顾性总结1例肝门部胆管癌患者行HPLT术后早期并发症的发生情况及处理方法。结果患者术后出现一过性消化道出血、盆腔脓肿形成、中肝静脉不完全堵塞、肝动脉栓塞、腹腔积液、输入袢抑制综合征等并发症，经积极有效的处理后痊愈，于术后3个月出院。至今无瘤生存28个月，移植肝功能及消化功能良好。结论HPLT术后并发症发生风险极高，加强术后出血、感染、移植肝血管并发症、胃肠吻合口漏、胃肠功能紊乱等并发症的观察及护理，能充分预防并减少并发症的发生。

Objective In order to know the nursing and observation points of hepatectomy pancreaticoduodenectomy with orthopic liver transplantation for patients with complication of carcinoma of bile duct in hepatic prota. Methods Summarized the perioperative nursing points of one patient with complications of carcinoma of bile duct in hepatic porta cured by hepatectomy pancreaticoduodenectomy with orthopic liver transplantation. Results Transient hemorrhage of digestive tract, pelvic abscess, incomplete obstruction of middle hepatic veins, hepatic artery embolism and afferent loop syndrome were occurred after the operation. While after the timely treatment and careful nursing, this patient obtain a fully recovery and discharged from hospital after 3 months, this patient is still living with good liver function and digestive function but without tumor recurrence for 28 months. Conclusion The risk of early complications is very high, so it is very important to emphasis the observation and attendance for hemorrhage, infection, hepatic artery comblication, stomal leak and gastrointestinal dysfunction for prevent and reduce the incidence of complications.