肝移植术后消化道出血的原因及处理

目的 探讨肝移植术后消化道出血的原因和处理方法.方法 对中山大学附属第一医院2000年1月至2006年12月施行的776例同种原位肝移植（OLT）患者的临床资料进行回顾性分析,总结原位肝移植术后消化道出血的诊治经验.结果 776例肝移植患者中共发生术后消化道出血18例（2.3%）.其中消化性溃疡出血8例（44.5%）,胃底食管静脉曲张急性出血3例（16.7%）,胃十二指肠炎出血3例（16.7%）,胆道出血3例（16.7%）,空肠憩室出血伴穿孔1例（5.6%）.分别采取积极的非手术治疗和经内镜直视下局部止血治疗、血管栓塞治疗和手术探查等措施,除死亡5例（27.8%）外,13例患者临床治愈,术后平均随访3.5年,除1例于术后2年死于移植肝癌复发外,其余均健康存活.结论 OLT术后可能出现不同部位的消化道出血,病死率较高：一旦发生,应尽快寻找出血部位并及时做出正确的治疗选择.

Etiology and management of postoperative gastrointestinal bleeding after orthotopic liver transplantation

Objective To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation(OLT).Methods Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.Results Gastrointestinal bleeding occurred in 18 patients(2.3%) after OLT,among whom 8(44.5%) were from peptic ulcer,3 (16.7%) from gastric and esophageal varices,3 (16.7%) from gastroduodenitis,3 (16.7%) from hemobilia,and 1 (5.6%) had diverticular bleeding in the jejunum.These 18 patients with gastrointestinal bleeding were managed with conservative treatment,endoscopic treatment,radiological interventional embolism,or exploratory laparotomy.Five patients died of gastrointestinal bleeding and the gastrointestinal bleedingrelated mortality rate was 27.8%.After a mean follow up of 3.5 years,only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.Conclusions Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high.Prompt identification of the source of bleeding and correct management are required to improve the prognosis.