肝移植围手术期并发症的处理

目的探讨肝移植围手术期并发症的发生规律及处理方法。方法回顾性分析44例肝移植病例的并发症及处理。结果32例发生肺部细菌性感染(72％)，其中13例合并真菌感染(29．5％)．死亡2例(15．3％)；急性肾功能不全(ARF)9例(20．4％)，7例须连续肾脏替代(CRRT)治疗，死亡3例(33．3％)；大量胸腔积液14例(31．8％)，无死亡；急性排斥反应5例(11．3％)，无死亡；腹腔内出血5例(11．3％)．死亡2例(40％)；胸腔内出血2例(4．5％)，无死亡；T管脱出2例(4．5％)．死亡1例(50％)。结论肝移植围手术期死亡主要与并发症有关．早期诊断与处理并发症，是提高肝移植存活率的重要措施。

The management of perioperative complication in liver transplantation

Objective To summarize the management of perioperative complication in orthotopic liver transplantation (OLTx).Methods The complication and the management in 44 cases of OLTx were analyized.Results Thirty (72%)patients suffercd from bacterial lung infection and 13(29.5%)patients combined with fungal infection,2(15.4%)patients were died.Acute renal failure(ARF)occurred in 9(9/44,20.4%)patients,7 patients underwent continuous renal replacement therapy (CRRT),3(3/9,33.3%)patients died.Mass of thoracic ascites in 14 (14/44,31.8%)patients.Acute rejection in 5 (5/44,11.3%) patients.5 (5/44,11.3%)patients occurred perioperative abdominal bleeding,2 (2/5,40%)patients died and 2 patients(2/44,4.5%)occurred thoracic bleeding.T type tube was pulled out in 2 patients(2/44,4.5%)and 1 died of abdominal infection.Conclusion The perioperative complication is a cause of mortality in OLTx.Early diagnosis and management of the complication is a major way to improve perioperative survival in OLTx.