肝移植后胰腺炎的诱因分析

Inducement of pancreatitis after liver transplantation

背景：肝移植后并发症中急性胰腺炎的发生率相对较低,但移植后重症胰腺炎的致死率确高达50%,加强对移植后并发胰腺炎的预防和治疗,对提高移植存活率具有重要意义。目的：回顾性分析肝移植后并发胰腺炎的治疗经验。设计、时间及地点：单中心抽样,回顾性病例分析,于2004-03/2008-03在解放军第二军医大学东方肝胆外科医院完成。对象：选取解放军第二军医大学东方肝胆外科医院单个医疗组同期内收治的肝移植患者117例,供者均为男性脑死亡志愿捐献者,供受者ABO血型符合。方法：肝移植患者后常规化验血淀粉酶,根据淀粉酶的最高值及临床表现分为正常组、淀粉酶偏高组（正常上限2倍以内）、单纯高淀粉酶血症组（正常上限2倍以上且无胰腺炎证据）及急性胰腺炎组（有明显临床症状及CT表现）。出现移植后高淀粉酶血症或怀疑胰腺炎的患者均予以抗胰腺炎治疗;对于诊断为急性胰腺炎的患者均予以血管活性物质治疗。主要观察指标：分析各组患者中各种风险因素的比例,总结移植后胰腺炎的预防及治疗经验。结果：117例肝移植患者中,移植后淀粉酶增高51例（占43.6%）,移植后单纯高淀粉酶血症24例（占20.5%）,急性胰腺炎3例（占2.6%,包括1例急性重症胰腺炎）。3例急性胰腺炎患者经抗胰腺炎治疗7-10d后,其中2例患者症状消失、血淀粉酶下降;1例患者持续腹胀、发热、血象升高,影像检查发现胰腺改变及胰腺周围积液,经2次开腹手术后逐渐痊愈,整个治疗时间40d。结论：充分地认识,积极地控制和治疗诱发因素,对降低肝移植后胰腺炎发生率具有重要意义。

BACKGROUND：Acute pancreatitis after liver transplantation is rare,but the fatality of severe pancreatitis after live transplantation is high as 50%.It is important to raise survival rate by emphasizing the prevention and treatment for pancreatitis after transplantation.OBJECTIVE：To retrospectively investigate the therapy experience of pancreatitis after liver transplantation.DESIGN,TIME AND SETTING：Single-center sample,retrospective case analysis was performed at the Eastern Hepatobiliary Surgery Hospital,Sencond Military Medical University of Chinese PLA from March 2004 to March 2008.PARTICIPANTS：117 patients underwent liver transplantation in Eastern Hepatobiliary Surgery Hospital,Sencond Military Medical University of Chinese PLA were selected.Donors were volunteers of brain death males.The donors and recipients were ABO matched.METHODS：After liver transplantation in patients with conventional laboratory tests of blood amylase,according to the highest amylase and the clinical manifestations,patients are divided into normal group,amylase high group（ 2 times normal limit）,simply hyperamylasemia group（ 2 times normal limit and no evidence of the acute pancreatitis）,acute pancreatitis group（obviously clinical symptoms and CT）.Patients affected hyperamylasemia or suspected with pancreatitis underwent anti-pancreatitis therapy.Patients with acute pancreatitis were treated with vasoactive substance.MAIN OUTCOME MEASURES：Proportion of various risk factors was analyzed in patients from each group.Prevention and treatment experiences of pancreatitis following transplantation were summarized.RESULTS：117 cases of liver transplantation patients,with high amylase 43.6%（51/117）,hyperamylasemia 20.5%（24/117）,acute pancreatitis 2.6%（3/117,including one case of severe acute pancreatitis）.After the therapy for pancreatitis for 7-10 days,symptoms in 2 cases disappeared and serum amylase decrease.The other case appeared on-going abdominal distention,fever,hyperleukocytosis;CT-imaging revealed changes in the pancreas and the effusion around pancreas.After twice laparotomy,the case gradually recovered after 40 days treatment.CONCLUSION：Full awareness and the positive preventive treatment have an important significance for reducing the incidence of postoperative pancreatitis.