肝移植术后腹腔出血原因分析及防治体会(附82例报告)

Analysis on cause,prevention and treatment of intra-abdominal hemorrhage after liver transplantation:a report of 82 cases

目的探讨肝移植术后腹腔出血的原因和防治措施。方法回顾性分析82例肝移植手术患者的临床资料,根据有否出现腹腔出血,分为腹腔出血组(12例)和对照组(70例)。比较两组患者术前各项指标,包括年龄、终末期肝病模型(MELD)评分、凝血酶原时间(PT)、凝血酶原时间国际标准化比值(PT-INR)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血小板(Plt);比较两组患者术中出血量、供肝冷缺血时间、无肝期时间、手术时间等参数;比较两组患者的病死率。结果 82例患者中,12例发生腹腔出血(发生率为15%),均需二次手术止血。其中腹腔出血组死亡4例(病死率为33%),对照组70例患者中死亡8例(病死率为11%),两组病死率比较差异无统计学意义(P>0.05)。两组患者的年龄、MELD评分、PT、INR、FIB、APTT、PLT等指标比较,差异均无统计学意义(均为P>0.05)。与对照组比较,腹腔出血组的术中出血量多、手术时间长及供肝冷缺血时间长,差异均有统计学意义(均为P<0.05),而两组的无肝期比较差异无统计学意义(P>0.05)。结论肝移植术后腹腔出血与供肝冷缺血时间长、术中出血量多及手术时间长有关。应在术前充分纠正凝血功能,提高外科手术技术,以减少术后腹腔出血发生率。

Objective To investigate the cause,prevention and treatment of intra-abdominal hemorrhage after liver transplantation. Methods Clinical data of 82 patients undergoing liver transplantation were retrospectively analyzed.All participants were divided into the intra-abdominal hemorrhage（ n = 12） and control groups（ n = 70）. Preoperative parameters including age,model for end-stage liver disease（ MELD） score,prothrombin time（ PT）,prothrombin time international normalized ratio（ PT-INR）,fibrinogen（ FIB）,activated partial thromboplastin time（ APTT）,platelet（ Plt）were statistically compared between two groups. Intraoperative hemorrhage volume,cold ischemia time of donor liver,anhepatic phase time and operation time were also compared between two groups. Postoperatively,the mortality rate was compared between two groups. Results Among 82 patients,12（ 15%） presented with intra-abdominal hemorrhage and required twice surgical hemostasis. In the intra-abdominal hemorrhage group,4 cases（ 33%） died,and 8（ 11%） died in the control group. No statistical significance was documented between two groups（ P〉0. 05）. Age,MELD score,PT-INR,FIB,APTT and PLT did not significantly differ between two groups（ all P〉0. 05）. Compared with patients in the control group,those in the intra-abdominal hemorrhage group yielded significantly more blood loss intraoperatively,longer operation time and longer cold ischemia time of donor liver（ all P〈0. 05）. Anhepatic phase time did not significantly differ between two groups（ P〉0. 05）. Conclusions After liver transplantation,intra-abdominal hemorrhage is associated with longercold ischemia time of donor liver,more intraoperative blood loss and longer operation time. In order to decrease the incidence of postoperative intra-abdominal hemorrhage,coagulation function should be completely corrected prior to surgery and the surgical skills should also be enhanced.