肝脏移植受体手术与外科相关并发症防治

The Prevention and Treatment of Surgical Complications after Liver Transplantation

目的总结防治肝移植受体手术后外科相关并发症的方法与经验。方法回顾性分析2000年1月-2006年12月32例行肝移植患者临床资料,其中肝豆状核变性3例,慢性重症肝炎3例,晚期肝硬化12例（其中淤胆性肝硬化2例）,原发性肝癌合并肝硬化12例,肝门部胆管癌合并肝硬化2例。结果所有手术均获成功,术中平均出血量3 600（1 000-10 000）ml,手术时间平均5.2（4-9）h。围手术期死亡3例,分别死于术后出血、急性肾衰和移植肝无功能。术后腹腔出血4例,胆漏4例,胆管狭窄2例,无血管并发症。结论肝移植受体手术创伤大,术中应仔细操作,严密止血,高质量完成各种管道的重建,可大大减少各种外科相关并发症。

Objective To summarize the characteristics and experiences of the treatment of early complications after liver transplantation. Methods The clinical data of 32 patients with liver transplantation were analyzed retrospectively from January 2000 to December 2006. There were 3 cases of Wilson＇s disease ,3 cases of chronic severe hepatitis, 12 cases of advanced liver cirrhosis （2 cases of which were cholestatie liver cirrhosis）, 12 eases of primary hepatoeellular carcinoma with liver cirrhosis, and 2 cases of hilar eholangiocarcinoma with cirrhosis. Results All operations were successful, the average volume of blood loss was 3 600（ 1 000 10 000）ml. The operation time was 5.2 （4 - 9）h. During the perioperative period, 3 cases died of postoperative bleeding, acute renal failure, and the transplanted liver disfunction respectively. The surgical complications included 4 eases of intra-abdominal hemorrhage, 4 cases of bile leakage, and 2 cases of bile duct stricture. There was no vascular complication. Conclusions The surgical trauma of the receptor of liver transplantation is severe. It is the key point to make hemostasis strictly, and to reconstruct the various channels primely for reducing the surgical complications after liver transplantation.