儿童亲体肝移植围手术期并发症分析

Analysis of the perioperative complications of the living related liver transplantation in children （report of 25 cases）

目的探讨儿童亲体肝移植围手术期并发症的原因及处理措施，为提高儿童亲体肝移植的临床疗效提供依据。方法回顾性分析2006年6月至2009年3月本院25例亲体肝移植患儿围手术期临床资料。其中胆道闭锁合并胆汁性肝硬化15例，肝豆状核变性（Wilson’s病）3例，肝糖原累积症2例，门静脉海绵样变性3例，急性药物性肝功能衰竭1例，原发性肝硬化1例。对其并发症的种类及原因进行分析，总结治疗措施。结果25例手术均获成功，围手术期死亡3例，其中1例于术后3d死于门静脉血栓；1例亲体肝移植术后7d出现肝动脉血栓形成，再次行尸体肝劈离式肝移植，术后1个月因消化道出血而死亡；1例术后感染曲霉菌死亡；其余22例痊愈出院。结论正确有效的围手术期处理及术后治疗，是儿童亲体肝移植成功的关键。

Objective To analyze the perioperative complications of the living related liver transplantation （LRLT） in children, and to assess the therapeutic effects of treatment for these complications. Methods The clinical data, including types of complication and the treat for these complication, of 25 children undergone LRLT, from Jun 2006 to Mar 2009, were analyzed retrospectively. The reasons for LRLT were biliary atresia with cirrhosis in 15 children, Wilson disease in 3, glycogen storage disease in 2, cavernous transformation of portal vein in 3, drug-induced acute liver failure in 1, and primary hepatic cirrhosis in 1. Results LRLTs were carried out successfully in all children. There were 3 children died. Among them, 1 died for pylethrombosis 3 days late and 1 for postoperative aspergillus infection, the other dead case had suffered with hepatic artery embolization 7 days after the operation and undergone splitted liver re-transplantation and died 1 month late because of the acute hemorrhage of upper gastrointestinal tract. The 22 survivors were discharged from the hospital with full recovery. Conclusions Accurate perioperative managements were critical for the success of LRLT in children.