背驮式肝移植术后神经精神并发症的防治

目的探讨背驮式肝移植患者术后神经精神并发症的防治对策。方法回顾性分析背驮式肝移植（PBLT）项目组235例中术后出现神经精神并发症的45例患者的病因、治疗反应及预后情况。结果神经精神并发症发生率19．1％（45／235），表现为躁狂者22例（48．9％），抑郁5例（11．1％），幻觉3例（6．7％），自杀倾向1例（2．2％），视物变形1例（2．2％），焦虑伴失眠8例（17．8％），适应障碍2例（4．4％），情感障碍3例（6．7％）；其中以谵妄样精神障碍最为多见，但大多数症状不严重，均治愈，仅1例昏迷患者头颅CT检查证实有颅内出血，抢救无效后死亡。结论背驮式肝移植术后神经精神并发症的发生率较高，但大多数病例症状较轻，预后较好。精神并发症出现后，针对不同病因，及时采用积极的综合治疗能改善患者的预后。     

肝移植术后神经精神系统并发症的预防和治疗

目的 探讨原位肝移植术后神经精神系统并发症的预防和治疗。方法 对2004年1月至2006年12月中山大学附属第一医院施行的516例同种原位肝移植病人神经精神系统并发症的临床资料进行回顾性分析。结果 全组神经精神系统并发症83例（16.1%）,其中弥漫性脑病67例（13.0%）,脑血管意外8例（1.6%）,癫痫发作7例（1.4%）,脑桥中央髓鞘溶解症2例（0.4%）,中枢神经系统感染2例（0.4%）,部分病例合并两种以上并发症,包括7例癫痫发作中,3例合并颅内出血。分别采取了病因治疗和对症处理相结合的综合防治措施,其中有7例脑病病人给与持续的人工肝替代治疗,2例颅内出血病人施行了开颅血肿清除术。83例病人中,死亡12例,与术后神经精神系统并发症相关病死率为14.5%（12/83）。结论 肝移植术后神经精神系统并发症发生率较高,临床表现形式多样;颅内出血和中枢神经系统感染的发生多提示预后不良;重视围手术期的预防,及时采取针对病因的综合治疗和调整免疫抑制药物可降低病死率。     

血浆置换联合连续性血液滤过在肝移植术后中央脑桥髓鞘溶解症的应用

肝移植术后发生神经系统并发症较常见,约占13%,其中以中央脑桥髓鞘溶解症(central pontine myelinolysis,CPM)预后最差[1].中山大学附属三院移植中心从2006年开始在营养神经、防治并发症等综合治疗的基础上采用血浆置换联合连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH),成功救治4例肝移植术后重症CPM病人,现总结如下.     

肝移植术后精神症状的临床分析

目的 探讨肝移植术后精神症状的发生原因和防治经验.方法 回顾性分析62例原位肝移植患者的临床资料,分析肝移植术后发生精神症状的影响因素,总结治疗经验.结果 16例患者于手术后3周内出现不同程度的精神症状,占全部患者的25.8％,其中4例症状严重.表现为:睡眠障碍、躁狂、焦虑、抑郁、谵妄及认知改变等.精神症状的发生与术前肝性脑病史、肝功能、术中出血量、术后在ICU时间、术后感染和免疫抑制剂浓度有关.全部病例都经治而愈.结论 肝移植术后的精神症状的发生率较高,病因及临床表现形式多样,需加强心理疏导,根据不同的病因及时采取相应的治疗措施,有助于改善患者的预后.     

腹腔镜腹股沟疝修补术术后并发症的临床分析

目的:探讨腹腔镜腹股沟疝修补术术后发生并发症的原因及对策。方法:回顾分析2007年8月至2009年3月我院行腹腔镜腹股沟疝修补术60例患者的临床资料。结果:本组患者发生的主要并发症为:暂时性神经感觉异常8.3%(5/60)、腹股沟区血清肿6.7%(4/60)、疝复发3.3%(2/60)、补片排斥反应1.7%(1/60)。结论:腹腔镜腹股沟疝修补术后并发症多与手术方法和操作有关,降低复发和并发症的关键是熟悉"耻骨肌孔"薄弱区的解剖。     

胃肠道腺癌并发阻塞性肺疾病的围手术期处理60例分析

目的探讨防治胃肠道恶性肿瘤合并阻塞性肺疾病(COPD)患者术后并发症的有效方法。方法回顾性分析60例胃肠道恶性肿瘤合并COPD患者的围手术期处理措施及其效果。结果术后11例患者出现并发症(18.3%),其中肺炎5例(8.3%),肺不张1例(1.7%),切口感染2例(3.3%),吻合口漏1例(1.7%),泌尿系感染1例(1.7%),肠梗阻1例(1.7%)。除1例肺炎发展为MODS死亡外,其余经非手术治疗后痊愈。结论围手术期采取综合措施可有效降低胃肠道恶性肿瘤合并COPD患者术后并发症的发生。     

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.     

肝移植术后神经精神并发症的临床诊治

目的探讨肝移植术后神经精神并发症的诊断、病因和防治：方法回顾性分析127例肝移植患者的临床资料,分析肝移植术后神经精神并发症的发生原因结果有症状组和无症状组在年龄上相比较差异无统计学意义（P〉0．05）;但在性别、手术时间、术前血氨水平、术中输血量、血总胆红素、血肌酐、住ICU时间．免疫抑制剂浓度、术后感染等方面,两组相比较,差异有统计学意义（P〈0．01）：结论肝移植术后神经精神并发症的发生率较高,病因及临床表现形式多样,需积极预防及时处理,提高肝移植手术的效果。     

器官捐献时代再次肝移植单中心回顾性研究

目的总结再次肝移植的病因、预后及并发症防治。 方法回顾性分析2015年1月至2019年12月复旦大学附属华山医院完成的26例再次肝移植供、受者临床资料。根据再次肝移植时间不同,将2015年1月至2017年12月(代表公民逝世后器官捐献时代早期再次肝移植治疗经验探索期)完成的再次肝移植受者纳入早期移植组(共9例),将2018年1月至2019年12月完成的再次肝移植受者纳入成熟期移植组(共17例)。根据移植间隔时间不同,将26例受者分为移植间隔>1年组(15例)和移植间隔≤1年组(11例)。采用两独立样本t检验比较早期与成熟期移植组受者再次肝移植术前年龄、终末期肝病模型(MELD)评分、手术时长、供肝冷和热缺血时间、无肝期时长及术后第7、14天血清白蛋白水平。采用Mann-Whitney U检验比较两组受者移植间隔时长、术中出血量和输血量以及术后第7、14天总胆红素、ALT和AST。采用Kaplan-Meier法计算再移植术后受者生存率并绘制生存曲线,采用Log-rank检验比较早期与成熟期移植组、移植间隔>1年与≤1年组受者术后2年生存率。P<0.05为差异有统计学意义。 结果再次肝移植病因包括：胆道并发症8例,移植物失功8例,原发病复发4例(肝细胞肝癌复发),慢性排斥反应2例,首次肝移植术后急性肝功能衰竭2例,血管并发症2例(门静脉血栓和肝动脉栓塞各1例)。早期移植组受者术中无肝期时长和术后第7天血清白蛋白分别为(53.3±7.9)min和(34±5)g/L,成熟期移植组受者分别为(45.1±1.8)min和(38±4)g/L,差异均有统计学意义(t＝3.098和-2.111,P均<0.05)。早期移植组肝移植术前年龄、MELD评分、移植间隔时长、手术时间、术中出血量、术中输血量、供肝冷和热缺血时间、术后第7天总胆红素、ALT和AST以及术后第14天总胆红素、ALT、AST和白蛋白差异均无统计学意义(P均>0.05)。随访至2020年10月1日,26例受者中位随访时间为715 d(105～1 842 d),期间9例受者均于术后1年内死亡(早期移植组6例,成熟期移植组3例)。早期移植组和成熟期移植组受者术后2年累积生存率分别为33.3%和82.4%,差异有统计学意义(χ²＝6.248,P<0.05)。移植间隔≤1年组和移植间隔>1年组受者术后2年累积生存率分别为54.5%和73.3%,差异无统计学意义(χ²＝0.990,P>0.05)。 结论胆道并发症及移植物失功能是再次肝移植的主要原因,器官捐献成熟时期的再次肝移植预后优于器官捐献时代早期。因再移植受者病情复杂、手术困难,应谨慎进行再次肝移植手术评估。合理的个体化治疗能够为再次肝移植受者带来良好预后。     

氟哌啶醇在肝移植术后精神障碍中的应用

目的:观察氟哌啶醇在肝移植术后精神障碍中的疗效。方法:回顾性分析我院2012年7月至2013年12月肝移植术后发生精神障碍受者使用氟哌啶醇的疗效与不良反应。结果:本研究受者发生精神障碍31例,占所有87例肝移植受者的35.6%,共使用氟哌啶醇72次,22例明显改善,5例好转,3例效果差,1例出现锥体外系反应,改用地西泮治疗。结论:精神障碍为肝移植术后常见的并发症,氟哌啶醇治疗具有较好的效果,大剂量使用时注意其不良反应。     

Central nervous system complications in liver transplant recipients--incidence, timing, and long-term follow-up

BACKGROUND: Neurological impairment is a major source of morbidity and mortality following orthotopic liver transplantation (OLT). We reviewed our experience with neurologic complications among our first 463 consecutive adult OLT recipients. METHODS: Between September 1988 and October 1993, 463 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications was obtained from patient charts, including autopsy results when available. CNS complications were classified by clinical presentation and by etiology. RESULTS: 93 patients (20.1%) had CNS complications following OLT. Encephalopathy (11.8%) and seizure (8.2%) were the leading complications. The incidence of immunosuppressive drug-related complications was 5.6%; coma, 1.7%; cerebral hemorrhage, 1.5%; central pontine myelinolysis (CPM), 1.2%; stroke, 0.6%; and primary CNS lymphoma, 0.2%. Most CNS events (80%) were encountered in the first month after OLT. In the majority of cases, encephalopathy (70%) and seizure (50%) presented in the first 2 wk. Although most CNS infections occurred early, 2 patients developed tuberculous meningitis more than 1 yr post-OLT. In 12 patients, death was directly related to CNS complications (2.6%). CONCLUSIONS: Most CNS complications occur early following OLT but may be seen even after 1 yr. Patients may survive serious neurologic events, such as cerebral hemorrhage, CPM, and meningitis.     

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??Prophylaxis and management of neuropsychiatric complications after liver transplantation MA Yi?? TAI Qiang, HE Xiao-shun?? et al. Departmentment of Transplantation Surgery??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080??China Corresponding author??MA Yi?? E-mail??anhuimayi2002@163.com Objective To study the prophylaxis and management of neuropsychiatric complications after othotopic liver transplantation(OLTx). Methods The clinical data of 516 cases performed allograft othotopic liver transplantation from January 2004 to December 2006 at the First Affiliated Hospital of Sun Yat-sen University were collected and analyzed retrospectively. The incidence and course of neuropsychiatric complications after OLT were summarized. Results There were 83 cases had neuropsychiatric complications??16.1%??including 67 cases??13.0%?? of diffuse encephalopathy, 8 cases??1.6%??of cerebrovascular accident, 7 cases??1.4%??of epileptic seizure ??including 3 cases of intracranial hemorrhage??,2 cases??0.4%??of central pontine myelinolysis and 2 cases??0.4%??of central nervous system infection. Integrated control therapy of etiological treatment and symptomatic treatment were taken to treat neuropsychiatric complications. Seven cases of encephalopathy were administrated persistent artificial liver replacement therapy and 2 cases of intracranial hemorrhage were performed craniotomy hematoma clearance. Of the 83 cases, 12 cases died, and the neuropsychiatric complications related mortality was 14.5%??12/83??. Conclusion Neuropsychiatric complications after OLT are common and have plenty of clinical manifestations. The occurrence of intracranial hemorrhage and central nervous system infection always suggest unfavourable prognosis. Thinking highly of perioperative prevention, taking etiotropic combined therapy and adjusting immunosuppressive drug can decrease mortality conspicuously.     

影响肝移植术后早期预后的相关危险因素分析

目的探讨影响肝移植术后早期预后的相关的危险因素。方法回顾性的分析了我院自2003年1月1日至2003年10月31日的原位肝移植病例171例。根据术后早期预后分为预后不良组及非预后不良组（术后早期住院期间死亡者或因各种并发症术后〉7d转出ICU者定为预后不良的病人），比较两组病人术前及术中的变量13项；并筛选出影响预后的一些变量。结果171例病人中，预后不良者30人（17．5％），其中围手术期死亡12人（7％）；应用单因素分析比较预后不良及非预后不良病人的各项指标，以下参数均具有显著性差异：Child分级、APACHEⅢ评分、UNOS分级、手术时间、出血量、输血及血浆量、术前cr水平、术前ICU、术前感染及再次手术干预。将预后作为因变量进行Logistic回归分析，筛选影响预后的危险因素，保留在回归方程中的变量有：APACHEⅢ评分、术前感染、手术时间、术中出血和输血量。而病人年龄、CHILD分级、UNOS分级、无肝期、术前Cr、术前ICU停留、再次手术干预被剔除方程。结论通过对肝移植病人术前及术中一些指标的评估，可以在一定程度上预测术后早期的预后。     

原位肝移植术后并发症的诊断和治疗

目的 总结7例原位肝移植术后并发症的诊治经验。方法 从1999年12月～2000年11月共施行原位肝移植7例。结果 全组存活5例,死亡2例。术后并发症包括:颅内出血、腹腔内出血、肺感染、胸腔积液、ARDS、急性排斥反应、高胆红素血症、下腔静脉狭窄等。结论 肝移植术后并发症较多;术中正确的手术操作,彻底细致的止血,术后凝血功能的调控,感染及肾功能不全的预防,高胆红素血症的对症处理,免疫抑制剂的合理使用等措施能有效地减少肝移植术后并发症的发生。     

Phenomenology and emotional impact of neuropsychiatric symptoms in orthotopic liver transplant for hepatocellular carcinoma

BACKGROUND: Few studies have focused on neuropsychiatric symptoms like hallucinations or delusions occurring in the early posttransplant period. The aim of this study was to estimate the percentage of patients reporting neuropsychiatric symptoms in the immediate postoperative phase, to describe the phenomenology, and to evaluate the emotional impact of such disorders. METHOD: We studied 94 consecutive patients who underwent orthotopic liver transplant (OLT) for hepatocellular carcinoma at least 30 days prior. The presence of neuropsychiatric symptoms were retrospectively evaluated through a semistructured interview. RESULTS: Overall 49 patients (52%) reported various postoperative neuropsychiatric symptoms. None of the demographic and clinical variables showed significant associations, except for barbiturate administration; patients using barbiturates showed a lower percentage of neuropsychiatric symptoms. It was a time-limited phenomenon that in most cases resolved by day 7 after transplantation. Interestingly, the most frequent emotion perceived was surprise and not fear; a nontrivial amount of patients reported happiness, while many patients reported no emotion. CONCLUSIONS: The results of this study suggested the usefulness of a registry of the neurological and psychiatric complications after OLT that may help to clarify the pathogenic mechanisms of such complications and implement uniform protocols of prevention and treatment. In fact, better knowledge of the phenomenology of neuropsychiatric symptoms in OLT recipients could allow easier symptom recognition and therapy adjustments on the basis of the emotional impact of such symptoms on patients, family, and caregivers, as well as increase patients' awareness and capability to face this experience.     

High incidence of recurrence and hematologic events following liver transplantation for Budd-Chiari syndrome

BACKGROUND: Most cases of Budd-Chiari syndrome (BCS) in Western countries are related to underlying hematologic diseases with inherent thrombogenic propensity. We evaluated the long-term outcome, risks for recurrent disease, and other hematologic complications following orthotopic liver transplantation (OLT) for BCS. METHODS: Clinical data from 11 consecutive patients with BCS who underwent OLT were retrospectively reviewed. Four patients had a prior transjugular intrahepatic portosystemic shunt and one had a surgical shunt procedure. All patients were started on intravenous heparin within the first 24 h following OLT. All except one patient who had protein C deficiency were maintained on long-term oral anticoagulation. RESULTS: The Kaplan-Meier survival rates at 1, 5 and 10 yr were 81, 65 and 65%, respectively. Three patients developed BCS recurrence, including two who died as a consequence of rapid graft failure within days after OLT. Three patients developed other thrombotic events, including splenic vein thrombosis associated with gastric variceal hemorrhage requiring splenectomy, portal vein thrombosis and pulmonary embolism. Four patients experienced severe bleeding complications within 7 d after OLT requiring exploratory laparotomy. One patient died after transformation of polycythemia vera to acute myelogenous leukemia at 2.1 yr after OLT. CONCLUSION: We observed a high incidence of recurrent BCS and complications related to the underlying hematologic disorder or anticoagulation after OLT for BCS. The present series also included the first two cases of rapid recurrence of BCS and graft failure within days after OLT.     

Incidence and indications for reintubation during postoperative care following orthotopic liver transplantation

STUDY OBJECTIVE: To analyze the incidence and indications for reintubation during postoperative care following orthotopic liver transplantation (OLT). DESIGN: Retrospective chart review. SETTING: Large metropolitan teaching hospital. PATIENTS: 546 adult liver transplant recipients. MEASUREMENTS AND MAIN RESULTS: The medical charts of 546 patients who underwent OLT at our institution between January 1992 and September 1996 were reviewed for the incidence and indications of reintubation throughout primary hospitalization. Eighty-one of 546 patients (14.8%) required one or more episodes of reintubation after OLT. In the majority of cases, reintubation was performed for pulmonary complications (44.6%), followed by cerebral (19.1%) and surgical (14.5%) complications. Cardiac (9.1%) and peripheral neurologic (2.7%) complications were less frequent reasons for reintubation. Overall patient survival, according to the Kaplan-Meier estimates, was 89.9%, 87.5%, 86.5%, and 82.2% after 1, 2, 3, and 5 years, respectively. In patients with one or more episodes of reintubation, overall survival decreased to 62.5% after 1, 2, and 3 years, and to 56.4% after 5 years (p < 0.001). CONCLUSIONS: The main indications for reintubation after OLT were pulmonary, cerebral, and surgical complications. These reintubation events had a considerable influence on the patient's postoperative recovery, and were associated with a significantly higher rate of mortality, than for OLT patients who did not undo reintubation.     

老年患者肝移植问题的研究

目的 总结老年患者（≥60岁）肝移植的疗效及相关问题。方法 回顾性分析59例≥60岁（i〉60岁组）及500例〈60岁（〈60岁组）接受原位肝移植术患者的临床资料,比较其术前、术中、术后相关数据和1年生存率等。结果 ≥60岁组1年生存率（66％）与〈60组（76％）的差异无统计学意义（P〉0．05）;两组手术时间、术中失血量、住院时间、肝动脉血栓发生率差异无统计学意义（P〉0．05）;≥60岁组急性排斥反应率低于〈60岁组,ICU停留时间、机械辅助通气时间长于〈60岁组,术后感染、脑出血发生率较〈60岁组高。老年患者肝移植术后的主要死因是感染和脑出血。结论 老年患者肝移植疗效满意,但术后并发症发生率较高。     

原位肝移植术后肝脓肿的原因和处理

目的：探讨原位肝移植术(OLT)后肝脓肿的病因及治疗选择。 方法：分析4年间行OLT 558 例术后1~18 个月发生肝脓肿10 例(1.8％)的原因。结果：7 例为术后胆道并发症,2 例为肝癌复发灶射频消融术（RFA）后,1 例为不明原因感染。主要临床表现有发热、肝功能损害、低蛋白血症和贫血等。诊断主要根据临床表现及超声或CT 检查。治疗方法主要包括脓肿抽吸引流、PTCD胆道内外引流、抗感染和支持治疗及再次肝移植。 10 例中6 例通过肝脏穿刺引流治愈,2 例通过再次肝移植治愈,2 例死于脓毒血症;治愈率为80.0％。结论：OLT 后发生肝脓肿地原因复杂,可能与胆管吻合口狭窄或梗阻、胆道缺血坏死、肝癌复发灶介入治疗、肝动脉血栓或狭窄和激素冲击治疗等有关。OLT 后肝脓肿的预后较差,早期诊断和治疗是关键。