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肝移植术后并发消化道穿孔六例报告
引用本文:游燊,何晓顺,朱晓峰,王东平,王国栋,胡红星,马毅,巫林伟,鞠卫强,胡安斌,邰强,黄洁夫. 肝移植术后并发消化道穿孔六例报告[J]. 中华器官移植杂志, 2007, 28(1): 31-33
作者姓名:游燊  何晓顺  朱晓峰  王东平  王国栋  胡红星  马毅  巫林伟  鞠卫强  胡安斌  邰强  黄洁夫
作者单位:510080,广州,中山大学附属第一医院器官移植中心
基金项目:教育部新世纪优秀人才计划(NCET-04-0794),广州市科技攻关计划(2006Z3-E0031),China Medical Board in New York(No.06837)
摘    要:
目的总结肝移植术后并发消化道穿孔的临床特点及诊疗体会。方法6例肝移植患者术后并发消化道穿孔,其中4例既往有腹部手术史。穿孔诊断时间在肝移植后7~12 d,确诊前2~4 d均有突发性腹部疼痛,但均能耐受,仅有1例腹痛较明显,上中腹压痛及反跳痛,其余5例腹肌不紧张,反跳痛不明显,6例均无明显的寒战及高热,5例的引流物细菌培养发现屎肠球菌感染,另1例未行引流物细菌培养。诊断明确后在全身麻醉下施行剖腹探查及穿孔修补术。结果3例(1例横结肠穿孔,1例胃壁、空肠穿孔,1例空肠憩室穿孔)穿孔直径较大,腹腔污染严重,手术过程中均出现感染性休克症状,分别于修补术后第2、9、33天死于多器官功能衰竭,另外3例(1例为回肠穿孔,1例为胃壁穿孔,1例为横结肠穿孔)的腹腔污染较轻,经穿孔修补术及营养支持治疗后痊愈。结论既往腹部手术史、医源性损伤及大剂量激素的应用,是导致肝移植后并发消化道穿孔的重要原因,而激素的应用使得患者的临床症状不明显,早期诊断、及时处理是治疗成功的关键。

关 键 词:肝移植  肠穿孔  手术后并发症  诊断  治疗结果
修稿时间:2006-07-26

Gastrointestinal perforation following orthotopic liver transplantation: Report of 6 cases
YOU Shen, HE Xiao-shun , ZHU Xiao- feng ,et al.. Gastrointestinal perforation following orthotopic liver transplantation: Report of 6 cases[J]. Chinese Journal of Organ Transplantation, 2007, 28(1): 31-33
Authors:YOU Shen   HE Xiao-shun    ZHU Xiao- feng   et al.
Affiliation:Organ Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Abstract:
Objective To investigate clinical characteristics, diagnosis and treatment of gastrointestinal perforation following orthotopic liver transplantation (OLT). Methods Six patients with intestinal perforation after OLT were studied, 4/6 cases with a history of abdominal operation. The time point of definitive diagnosis was at day 7-12 after transplantation. All patients experienced a sudden abdominal pain 2-4 days before diagnosis was confirmed. Only one case suffered from severe abdominal pain with tenderness and rebound tenderness on media-upper abdomen. The rest had no evident physical signs. None of them was presented with high fever and chill. Entercoccus facium was found in the drainage bacterial culture in 5/6 cases, while the remaining patient didn't undergo pathological examination. Exploratory laparotomy and perforation neoplasty were performed as soon as perforation was diagnosed. Results Three patients (perforation of transverse colon, gastric wall and jejunum, jejunum diverticulum respectively) suffered septic shock during operation because of big perforated diameter and severe abdominal cavity contamination.The patients died of multiple organ failure on day 2, day 9 and day 33 after perforation repair procedure. The remaining 3 cases (perforation of ileum, gastric wall and one transverse colon respectively) survived after perforation neoplasty and nutritional supportive therapy since the abdominal cavity was relatively clean. Conclusion The major risk factors of gastrointestinal perforation after OLT are history of abdominal operation, iatrogenic injury and high-dose corticosteroids therapy which makes the symptoms obscure. Early diagnosis and appropriate treatment are crucial for improving prognosis.
Keywords:Liver transplantation  Intestinal perforation  Postoperative complications  Diagnosis  Treatment outcome
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