肝移植术后早期腹腔内出血的防治

目的 分析原位肝移植术后早期腹腔内出血的原因及防治方法.方法 回顾性分析本科204例原位肝移植的临床资料,术后早期腹腔内出血患者共10例,其中6例接受2次探查手术,术中见其出血部位分别为:下腔静脉前壁肝短静脉结扎线脱落出血1例、右侧肾上腺创面出血1例、肝周创面渗血1例、肝动脉吻合口出血1例、腹壁动脉出血1例、未见明确活动性出血1例.结果 6例2次手术止血患者均顺利恢复.4例保守治疗患者中2例出血停止,顺利恢复,1例出血停止,术后腹腔内感染,经穿刺引流和抗感染治疗后康复,1例再次移植患者术后凝血功能障碍,于术后第3日死亡.结论 肝移植术后早期腹腔内出血多由于外科因素所致,外科技术的改进、正确诊断和及时处理是防治的关键.

PREVENTION AND TREATMENT OF EARLY INTRA-ABDOMINAL HEMORRHAGE AFTER OTHOTOPIC LIVER TRANSPLANATION

Objective To analysis the causes of early intra-abdominal hemorrhage after orthotopic liver transplantation and find out effective measure of prevention and treatment.Methods The clinical data of 204 patients underwent orthotopic liver transplantation,including 10 cases of early intra-abdominal hemorrhage after orthotopic liver transplantation,were analyzed retrospectively.Six of 10 cases received second explorative operation,and hemorrhage of IVC was found in 1 case,hemorrhage of right adrenal gland in 1 case,hemorrhage of raw surface around liver in 1 case,anastomotic hepatic artery hemorrhage in 1 case,abdominal wall artery hemorrhage in 1 case and no obvious active bleeding in 1 case.Results All the 6 patients received second operation in time and recovered well.Among the other 4 cases without second operation,2 of them recovered well with bleeding stopped.One patient's bleeding was controlled,while intra-abdominal infection developed and recovered with the treatment of puncturative drainage and antibiotics.Only 1 case with second transplantation died on day 3 after surgery because of poor transplanted liver function and coagulation disorders.Conclusions The early intra-abdominal hemorrhage after orthotopic liver transplantation is mainly due to surgical technique.The improvement of surgical technique,correct diagnosis and timely second operation are important for the treatment of intra-abdominal hemorrhage.