肝移植术后神经系统并发症的临床分析

Clinical analysis of neurological complications after liver transplantation

目的探讨肝移植术后神经系统并发症的病因与诊治原则。方法回顾性研究2002年4月至2007年2月解放军总医院第二附属医院全军器官移植中心249例原位肝移植的临床资料，分析术后神经系统并发症的病因、临床特点及总结治疗经验。结果249例肝移植受体中，27例术后出现神经系统并发症（10．84％）。其中，脑病8例（29．63％），包括中枢神经系统脱髓鞘病变2例，经适度脱水、营养神经及对症支持治疗后均康复；癫痫2例（7．41％），均治愈；颅内出血4例（14．81％），其中3例行手术治疗，均留有后遗症；中枢神经系统感染4例（14．81％），2例治愈，2例因真菌感染死亡；锥体外系损害和周围神经病变并发症分别是6例（22．22％）和7例（25．93％），随免疫抑制剂减量，均逐渐好转。结论肝移植术后神经系统并发症发生率较高，系由多种病因引起，临床症状多样，针对其不同病因及时对症处理，可有效改善、控制病情，使病人得以长期生存。

Objective To investigate the etiological factors and treating principle for neurological complications after liver transplantation. Methods The clinical data of 249 patients receiving orthotopic liver transplantation in our hospital from April 2002 to February 2007 were retrospectively analyzed to summarize etiological factors, clinical features and treatment experience of neurological complications. Results The neurological complications occurred in 27 cases, accounting for an incidence ratio of 10.84%. For these 27 cases, 8（29.63%）were with eneephalopathy （including 2 cases with central pontile myelolysis recovered after moderately dehydration, trophic nerve, symptomatic and supportive treatment）, 2 （7.41% ） with epilepsia were cured, 4 cases （ 14.81%） with intracranial hemorrhage （including 3 cases undergoing operation and had lingering effects but survived）, 4（14.81%） with infection of central nervous system （2 were cured and the other 2 died from fungous infection）. It was found that 6 cases（22.22% ）with extraeorticospinal tract damage and 7 （25.93%） with peripheral neuropathy were improved gradually after drug dose was decreased. Conclusion The neurological complications are common after liver transplantation and have a variety of etiology and clinical symptoms. The specific and prompt treatment for different etiological factors can improve and control the complications effectively. Many patients may survive for a long time.