肝移植术后神经系统并发症的临床分析

目的 探讨肝移植术后神经系统并发症的病因与诊治原则.方法 回顾性研究2002年4月至2007年2月解放军总医院第二附属医院全军器官移植中心249例原位肝移植的临床资料,分析术后神经系统并发症的病因、临床特点及总结治疗经验.结果 249例肝移植受体中,27例术后出现神经系统并发症(10.84%).其中,脑病8例(29.63%),包括中枢神经系统脱髓鞘病变2例,经适度脱水、营养神经及对症支持治疗后均康复;癫痫2例(7.41%),均治愈;颅内出血4例(14.81%),其中3例行手术治疗,均留有后遗症;中枢神经系统感染4例(14.81%),2例治愈,2例因真菌感染死亡;锥体外系损害和周围神经病变并发症分别是6例(22.22%)和7例(25.93%),随免疫抑制剂减量,均逐渐好转.结论 肝移植术后神经系统并发症发生率较高,系由多种病因引起,临床症状多样,针对其不同病因及时对症处理,可有效改善、控制病情,使病人得以长期生存.

Clinical analysis of neurological complications after liver transplantation

Objective To investigate the etiological factors and treating principle for neurologi-cal complications after liver transplantation. Methods The clinical data of 249 patients receiving ortho-topic liver transplantation in our hospital from April 2002 to February 2007 were retrospectively ana-lyzed to summarize etiological factors, clinical features and treatment experience of neurological com-plications. Results The neurological complications occurred in 27 cases, accounting for an incidence ratio of 10.84%. For these 27 cases, 8(29.63%)were with encephalopathy (including 2 cases with central pontile myelolysis recovered after moderately dehydration, trophic nerve, symptomatic and supportive treatment), 2 (7.41%) with epilepsia were cured, 4 cases(14.81%) with intracranial hem-orrhage (including 3 cases undergoing operation and had lingering effects but survived), 4(14.81%) with infection of central nervous system (2 were cured and the other 2 died from fungous infection). It was found that 6 cases(22.22%)with extracorticospinal tract damage and 7 (25.93%) with peripheral neuropathy were improved gradually after drug dose was decreased. Conclusion The neurological complications are common after liver transplantation and have a variety of etiology and clinical symp-toms. The specific and prompt treatment for different etiological factors can improve and control the complications effectively. Many patients may survive for a long time.