原位肝移植术后消化道出血的病因与治疗

Gastrointestinal bleeding following orthotopic liver transplantation

目的探讨原位肝移植术后消化道出血的病冈与治疗。方法回顾性分析16例肝移植术后消化道}fJ血患者的临床资料，总结其病闪与治疗经验。结果16例患者发牛消化道出血的时间在肝移植术后2d～4．5年。经检查发现患者的}H血原因主要为食道静脉曲张破裂出血4例，急性胃黏膜病变m血3例．门脉高乐性胃病出血3例．十二指肠球部多发性溃疡出血2例，十二指肠降段黏膜下小动脉出血、十二指肠乳头肌切开后小血、胆道出血及不明原闪出血各1例。有2例经止血治疗无效而死产。1例存肝移植罔手术期死于多器官功能衰竭，1例死于急性心肌梗死．1例死于晚期肿瘤，其他患者经过积极止血治疗后好转，并长期存活。结论肝移植术后消化道出血的病因主要为食道静脉曲张破裂出血、急性胃黏膜病变、门脉高压性胃病及消化性溃疡等。采用及时的止血治疗．必要时行剖腹探查手术止血是治疗成功的关键。

Objective To study the causes and therapeutic experiences of gastrointestinal bleeding following ortholopic liver transplantation （OLT）. Methods he causes and outcomes of 16 pa tients with gastrointestinal bleeding following OLT were retrospectively studied. Results The bleeding appeared from 2nd day to 54th month post-OLT. The causes of bleeding included gastroesophageal variceal （4 cases）, acute gastric mucosa lesion （3 cases） . portal hypertension gastritis （3 cases）, duo denal multi ulceration （2 cases）, artery injury on descending duodenum （l case）, hemorrhage post-en doscopic sphincterotomy （ 1 case）, biliary bleeding （1 case） and indefinite cause （ 1 case）. Two cases died from ineffective hemostasis, One case died from multiple organ failure during the perioperation of OLT. Ono case died from acute myocardium scarce. Two cases died from advanced tumor. The remaining cases had a long-term survival by effective treatment of hemostasis. Conclusions The main causes of gastrointestinal bleeding post OLT are gastroesophageal variceal, acute gastric mucosa lesion, hy pertension gastritis and digestive ulcer, Emergency endoscopic check plays an important role in the diagnosis of bleeding. It is also necessary to perform exploratory laparotomy on some cases.