肝移植术后合并急性胰腺炎的回顾性分析

Acute Pancreatitis after Liver Transplantation:A Retrospective Analysis

目的总结肝移植术后合并急性胰腺炎的诊断及预防治疗经验。方法对我院2006～2009年肝移植术后合并急性胰腺炎患者的临床资料进行回顾性分析。结果本组肝移植后急性胰腺炎的发生率为5.6%(6/107),33.3%的急性胰腺炎并发患者移植术中存在胰腺损伤。起病后诊断时间和治疗时间分别为(5.1±1.1)d和(21.4±16.3)d;术后血淀粉酶和尿淀粉酶恢复时间分别为(8.0±4.1)d和(16.1±4.4)d;1例术后1个月时发现直径3cm的胰腺假性囊肿,1例术后2个月并发感染中毒性休克和多器官功能衰竭,除此外无明确并发症,并发症发生率33.3%。目前5例患者健康存活,无胰腺炎复发及慢性胰腺炎出现,治愈率83.3%。1例2个月时死于感染中毒性休克、多脏器功能衰竭,死亡率16.7%。结论肝移植术中对胰腺的骚扰是并急性胰腺炎的主要因素,诊治关键在于早期预防、早期诊断及早期正规治疗。

Objective To summarize the diagnosis and prevention and treatment of acute pancreatitis after liver transplantation. Methods We analyzed clinical data of 6 patients with acute pancreatitis after 107 liver transplantation patients in our hospital from 2006 to 2009. Results The incidence of acute pancreatitis after liver transplantation was 5.6%（6/107）, and the damage of the pancreas was found during the transplantation in 33.3%（2/6）of patients with acute pancreatitis after liver transplantation. The diagnosis time and treatment time after the onset were（5.1 ±1.1 ）days and（21.4 ±16.3）days,respectively. The recovery time of hemodiastase and urinary amylase after surgery was（8.0 ±4.1 ） days and（16.1 ±4.4） days,respectively. One case of pancreatic pseudocyst 3cm in diameter was found one month after surgery,with the complication incidence of 33.3%.One case died of toxic shock and multiple organ failure two month after surgery,with the mortality rate of 16.7%. Five cases still survived and remained healthy, and non-recurrent pancreatitis and chronic pancreatitis occurred,with the cure rate of 83.3%. Conclusion Pancreas injure during liver transplant may be the most important factor for acute pancreatitis after liver transplantation. The key to control acute pancreatitis after liver transplantation is to prevent, diagnoze and regularly treat it as early as possible.