原位肝移植后的严重腹腔感染

Severe abdominal infection after orthotopic liver transplantation

背景:肝移植后严重腹腔感染是肝移植受者围手术期严重并发症,是导致患者死亡或者移植肝失功能的重要原因之一。目的:探讨原位肝移植后严重腹腔感染的发病原因及诊治经验。方法:回顾性分析2004年3月至2011年11月作者参与实施的186例原位肝移植患者发生严重腹腔感染的临床资料。结果与结论:186例患者中发生严重腹腔感染16例,其中5例胆管吻合口漏致肝下间隙大量积液并感染;10例肝移植手术创面广泛渗血致肝周大量积血并感染,1例移植后食道下段瘘致左侧膈下大量积液并感染。诊断明确3 d内再次手术12例,均无死亡;诊断明确3 d后再次手术4例,其中1例于肝移植后21 d、再次术后5 d因多器官功能衰竭死亡。结果可见肝移植后严重腹腔感染是肝移植受者围手术期严重并发症之一,采取积极复苏、多脏器功能支持、控制性手术清除感染病灶以及充分引流等综合治疗措施是治疗肝移植后腹腔严重感染的关键。

BACKGROUND： Severe abdominal infection after liver transplantation is the serious perioperative complications in liver transplant recipients, and it is one of the major reasons of death or loss of liver function. OBJECTIVE： To investigate the etiology, diagnosis and treatment of severe abdominal infection after orthotopic liver transplantation. METHODS： The clinical data of 186 cases of abdominal infection that received orthotopic liver transplantation between March 2004 and November 2011 were retrospectively analyzed. RESULTS AND CONCLUSION： Among the 186 patients, 16 patients had severe abdominal infection. Among the 16 patients, five patients had the infection due to the biliary anastomotic leakage caused large effusion in the gap under liver; 10 patients had infection due to the peripheral liver massive hematocele caused by liver transplant surgery wounds extensive bleeding; one patient had injection due to left subphrenic large effusion caused by lower esophagus fistula after transplantation. Twelve patients had second operation within 3 days after diagnose, and there was no death; four patients had second operation after diagnosed for 3 days, one patient dead due to multiple organ failure at 21 days after liver transplantation and 5 days after second surgery. The results show that severe abdominal infection after liver transplantation is one of the serious perioperative complications in liver transplant recipients, and active recovery, multiple organ support and removal of infected lesions with controlling surgery as well as the adequate drainage and other comprehensive treatment measures are the key points for the treatment of severe abdominal infection after liver transplantation.