胆道闭锁患儿肝移植术后并发症分析

An analysis of postoperative complications in children with biliary atresia after liver transplantation

目的分析肝移植治疗胆道闭锁患儿术后并发症及预后。方法回顾性分析2006年6月-2014年4月于重庆医科大学附属儿童医院完成初次肝移植的41例胆道闭锁患儿临床资料,其中活体肝移植28例,心脏死亡器官捐献(DCD)供肝肝移植13例。活体与DCD肝移植受者术后随访时间分别为67~90个月和15~56个月,总结围手术期及随访期并发症发生情况及预后。计数资料组间比较采用Fisher's精确概率法。结果 41例肝移植受者围手术期并发症包括:血管并发症、腹腔出血、肠穿孔、排斥反应、感染并发症等。DCD肝移植组肝动脉栓塞(HAT)的发生率明显高于活体肝移植组(P=0.02)。围手术期死亡10例,其中活体肝移植组4例,包括HAT 1例;因HAT再次行DCD肝移植1例,后因原发肝无功能死亡;呕吐窒息1例;多器官功能衰竭1例。DCD肝移植死亡6例,包括HAT 1例;肺部肺炎克雷伯杆菌感染1例;肠漏后感染性休克1例;循环衰竭1例;严重毛细血管渗漏综合征1例;原发肝无功能1例。随访期活体肝移植死亡4例,包括肝静脉狭窄2例;胆道感染1例;胆道狭窄1例。DCD肝移植随访期间未发生死亡及其他并发症。结论胆道闭锁肝移植术后并发症多样,是影响肝移植手术成功率及长期生存率的重要因素,早期预防、早期发现、及时治疗,对改善肝移植患儿预后至关重要。

Objective To investigate the postoperative complications and prognosis of children with biliary atresia treated with liver transplantation.Methods A retrospective analysis was performed for the clinical data of 41 children with biliary atresia who underwent primary liver transplantation in The Affiliated Children＇s Hospital of Chongqing Medical University from June 2006 to April 2014.Among these children,28 underwent living donor liver transplantation（ LDLT） and 13 underwent liver transplantation from donation after cardiac death（ DCD） donors.The children undergoing LDLT or DCD liver transplantation were followed up for 67- 90 months and 15- 56 months,respectively.The complications in the perioperative period and follow- up and prognosis were analyzed.The Fisher＇s exact test was used for comparison of categorical data between groups.Results Perioperative complications mainly included vascular complications,intra- abdominal hemorrhage,intestinal perforation,rejection reaction,and infection.The incidence of hepatic artery thrombosis in DCD groups was significantly higher than LDLT groups（ P = 0.02）.A total of 10 children died in the perioperative period,among whom 4 underwent LDLT（ 1died of hepatic artery thrombosis,1 underwent DCD liver transplantation due to hepatic artery thrombosis and later died of primary graft failure,1 died of suffocation caused by vomiting,and 1 died of multiple organ failure） and 6 underwent DCD liver transplantation（ 1 child each died of hepatic artery thrombosis,pulmonary Klebsiella pneumoniae infection,septic shock after intestinal leakage,circulatory failure,severe capillary leak syndrome,and primary graft failure）.During the follow- up,4 children undergoing LDLT died,among whom 2 died of hepatic vein stenosis,1 died of biliary tract infection,and 1 died of biliary stricture.No children undergoing DCD liver transplantation died or experienced complications during follow- up.Conclusion Various complications after liver transplantation in children with biliary atresia are important factors affecting the success rate of liver transplantation and long- term survival rates.Early prevention,early diagnosis,and timely treatment are very important to improve the prognosis of children undergoing liver transplantation.