原位肝移植术后呼吸系统并发症的原因与护理

肝移植术后的呼吸系统并发症是影响移植肝功能恢复和围手术期死亡的重要因素。及时发现并处理肝移植术后的呼吸系统并发症是手术成败的关键也是术后护理工作的重点。2005年1月-2006年7月，我院共施行成人原位肝移植63例其中38例发生呼吸系统并发症。现报告如下进行原因分析并总结护理体会。     

原位肝移植术后胆道并发症的内镜治疗

原位肝移植术后胆道并发症是肝移植后常见的并发症，胆道并发症临床上处理较棘手，再次手术创伤大，并发症多、死亡率高、重复性差。近几年，随着内镜技术的使用，使肝移植术后胆道并发症的治疗倾向于简单。我院共行9例同种异体原位肝移植术，3例术后发生胆道并发症，通过内镜治疗，取得近期满意疗效，结合文献复习，以探讨内镜治疗的价值，为临床提供参考。     

肝移植患者术后早期心血管并发症

肝移植已成为终末期肝病和暴发型肝功能衰竭的一种有效治疗方式。但由于手术本身的特点和术前患者的基础状况较差,术后易并发心血管系统的并发症,并影响全身各器官功能,进而影响预后。本文重点阐述肝移植术后早期心血管并发症—高血压、心力衰竭、心肌缺血和肺动脉高压的原因及其防治策略。     

原位肝移植术后并发症的诊治体会(附17例报道)

我院自2004年3月-2005年6月期间,施行同种异体原位肝移植(OLT)17例.现就这17例患者术后并发症的诊断和处理经验总结如下.     

原位肝移植术后肝脓肿的诊断和治疗

目的 探讨原位肝移植术(OLT)后肝脓肿的病因、诊断、治疗和预防措施。方法自1993年1月至2003年6月，本中心共行OLT274例，术后并发肝脓肿6例(2．2％)。患者主要临床表现有发热、寒战、腹痛、身目黄染、肝功能损害、低蛋白血症、贫血、白细胞及中性粒细胞比例增高等。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、清除胆泥．抗炎和支持治疗。结果6例中2例治愈，3例放弃再次肝移植术，2例死于严重全身感染，治愈率为33．3％。结论OLT后肝脓肿病因较复杂，可能与肝动脉血栓或狭窄、甲基强的松龙冲击治疗、胆管炎症和介入治疗等有关。OLT后肝脓肿的预后较差．应加强预防措施防止其发生。     

肝移植术后脑血管并发症9例分析

肝移植术后神经系统并发症发生率为8％～47％，其中脑血管疾病发生率约占整个神经系统并发症的50％。我院自1993年1月至2004年11月，共实施原位肝移植术487例，其中9例术后出现脑血管并发症，现报道如下。     

原位肝移植术后早期并发症护理（附1例报道）

原位肝移植术是现阶段治疗终末期肝病最有效的方法。目前，肝移植术后5年生存率为75％～85％。肝移植术后并发症是直接影响疗效的主要原因。因此，对早期并发症的及时发现治疗和护理是确保肝移植手术成功的关键。     

小型猪原位肝移植术的体外静脉转流

大动物的原位肝移植实验是开展临床肝移植的重要的动物模型。我科于 2 0 0 1年 11月至 2 0 0 2年 4月间采用贵州小香猪行原位肝移植 19次 ,全部行离心泵体外静脉转流 ,取得了较好的手术效果。材料与方法贵州小型香猪 3 8头 ,雌雄兼有 ,体重 12 .5～ 2 3 .5ｋｇ ,供受体体重相近     

肝移植术并发症的病理变化

目前,原位肝移植在国内已得到较广泛开展,在手术技术日臻完善的基础上,防治术后并发症,提高患者生存时问及健康质量已成为肝移植的重点课题.     

肝移植与胆管并发症——原位肝移植后胆管并发症的治疗

背景：尽管原位肝移植的存活率有所改善，但胆管并发症仍然是导致其死亡的主要因素。本研究的目的是对苏格兰肝移植中心病例的发病率、治疗回顾性分析以寻求胆管并发症的最佳治疗途径。     

Neurological complications after orthotopic liver transplantation

BACKGROUND: The number of orthotopic liver transplantation performed each year is increasing due to increased safety and logistic facilities. Therefore, the importance of reducing adverse events is progressively growing. AIM: To review present knowledge on the neurological complications of orthotopic liver transplantation. METHODS: The epidemiology, the clinical features and the pathophysiology of the neurological complications of orthotopic liver transplants, resulting from a systematic review of the literature in the last 25 years, are summarized. RESULTS AND CONCLUSIONS: The review highlights that a relevant variety of neurological adverse events can occur in patients undergoing orthotopic liver transplantation. The knowledge of neurological complications of orthotopic liver transplantation is important for transplantation teams to reduce their prevalence and improve their management. In addition, the likelihood of neurological adverse effects provides evidence for the need of a careful cognitive and neurological work up of patients in the orthotopic liver transplantation waiting list, in order to recognize and interpret neurological dysfunction occurring after orthotopic liver transplantation.     

肝移植术后胆道并发症的磁共振评价

目的:探讨磁共振胰胆管成像(MRCP)联合MR断面图像在诊断肝移植术后胆道并发症中的应用价值.方法:对57例肝移植术后怀疑有胆道并发症的患者行MR检查,分析其表现,并与手术、胆道造影、肝脏活检和,临床随访结果进行对照.比较MRCP和MRCP联合MR断面图像对胆道并发症诊断的确诊率.结果:57例患者胆道并发症发生率64.9%(37/57).其中吻合口狭窄患者14例,非吻合口狭窄8例.孤立性胆道结石或胆泥淤积5例,胆管炎及胆管周围炎3例,胆汁湖/胆汁瘤3例,供体-受体胆总管不匹配3例,肝外胆管吻合后过长1例.对胆道并发症诊断的准确率,MRCP为75.7%(28/37),MRCP联合MRI断面图像为94.6%(35/37),两者差别有统计学意义(P<0.05).结论:MRCP联合MR断面图像能提高胆道并发症诊断的准确性.     

肝移植后远期并发症的病理分析

目的 通过观察肝移植后远期并发症患者的肝组织形态学表现,了解并发症的发生情况.方法 对129例同种异体原位肝移植(OLT)术后远期发生各种并发症的患者行经皮肝穿刺,取肝组织活检标本行HE染色,部分行网状纤维组织染色和免疫组织化学染色,以检测肝组织内乙型肝炎表面抗原、乙型肝炎核心抗原、HCV抗原、巨细胞病毒抗原、EB病毒抗原的表达.对排斥反应病例,依照国际统一的Banff标准进行分级,应用排斥活动指数进行程度评分.结果 129例患者共行肝穿刺168例次,并发症中以急性排斥反应最常见,为61例次(36.31％);其次为药物性肝损伤,共30例次(17.86％),随后依次为丙型肝炎复发21例次(12.5％),乙型肝炎复发15例次(8.93％),胆道并发症14例次(8.33％),慢性排斥反应11例次(6.55％),巨细胞病毒感染6例次(3.57％),血管并发症5例次(2.98％),自身免疫性肝病复发5例次(2.98％).结论 肝移植后经皮肝穿刺活组织检查在多种并发症的诊断及鉴别诊断中具有重要价值.与围手术期不同,轻度急性排斥反应、药物性肝炎和病毒性肝炎复发是肝移植后远期主要的并发症.     

Endoscopic management of biliary complications after orthotopic liver transplantation

BACKGROUND: Biliary complications are a serious problem in patients after liver transplantation and often require reoperation. This study was conducted to summarize the endoscopic diagnosis and management of biliary complications after orthotopic liver transplantation (OLT). METHODS: From December 2000 to November 2003, twelve endoscopic retrograde cholangiopancreatographies(ERCPs) were performed in 7 patients after OLT at Digestive Endoscopic Center of Changhai Hospital in Shanghai, China. The therapeutic maneuvers included endoscopic sphincterotomy (EST), biliary stent placement, balloon and basket extraction, irrigation, and nasobiliary tube placement. A retrospective study was made to determine the types of biliary tract complications after OLT. The success of ERCP and therapeutic maneuvers was also evaluated. RESULTS: Biliary tract complications including biliary stricture, biliary leak, biliary sludge, and stump leak of the cyst duct were treated respectively by endoscopic sphincterotomy with sludge extraction, stricture dilation or endoscopic retrograde biliary drainage. Two of the 3 patients with proximal common bile duct stricture were successfully treated with ERCP and stent placement. Four patients with anastomotic stricture and/without bile leak were treated successfully by dilation and stent placement or endoscopic nosobiliary drainage. No severe ERCP-related complications occurred. CONCLUSIONS: ERCP is an effective and accurate approach for the diagnosis of biliary tract complications after OLT, and placement of a stent is a safe initial treatment for biliary complications after liver transplantation.     

原位肝移植术后胆道并发症诊治134例

目的:探讨原位肝移植术后胆道并发症的预防和治疗.方法:回顾性分析2004-10/2006-01施行的134例肝移植患者的临床资料.结果:18例患者(共20例次)出现胆道并发症,治愈17例,1例放弃治疗.其中胆道狭窄12例次,胆漏2例次,胆管结石6例次.与T管相关的胆道并发症发生率为11.7%(14/120).胆道并发症组冷缺血时间(624min)和二次热缺血时间(60min)均高于无胆道并发症组(384min,43min,均P<0.05).结论:保存性损伤和缺血性损伤是肝移植术后胆道并发症的重要原因.术后早期胆道造影并联合应用核磁共振胆管成像有助于及时诊断胆道并发症.介入技术是胆道并发症的主要治疗手段.     

Medical management of metabolic and cardiovascular complications after liver transplantation

Liver transplantation represents the only curative option for patients with endstage liver disease, fulminant hepatitis and advanced hepatocellular carcinoma.Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period, long-term survival is hampered by the lack of improvement in survival in the late post transplantation period(over 5 years after transplantation). The main etiologies for late mortality are malignancies and cardiovascular complications. The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components(arterial hypertension, dyslipidemia, obesity, renal injury, etc.). These comorbidities result from a combination of pre-liver transplant features, immunosuppressive agent side-effects, changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle. In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation, as well as proposing management strategies.     

Biliary complications after deceased-donor orthotopic liver transplantation

A wide range of potential biliary complications can occur after orthotopic liver transplantation (OLT). The most common biliary complications are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dyfunction, which may occur in up to 20%–40% of OLT recipients. Leaks predominate in the early posttransplant period; stricture formation typically develops gradually over time. However, with the advent of new techniques, such as split-liver, reduced-size, and living-donor liver transplantation, the spectrum of biliary complications has changed. Risk factors for biliary complications comprise technical failure; T-tube or stent-related complications; hepatic artery thrombosis; bleeding; ischemia/reperfusion injury; and other immunological, nonimmunological, and infectious complications. Noninvasive diagnostic methods have been established and treatment modalities have been modified towards a primarily nonoperative, endoscopy-based strategy. Besides, the management of biliary complications after OLT requires a multidisciplinary approach, in which interventional and endoscopic treatment options have to be weighed up against surgical treatment options. The etiology and spectrum of bile duct complications, their diagnosis, and their treatment will be reviewed in this article.