婴幼儿肝移植后的近期并发症

背景：婴幼儿肝移植作为肝移植领域的难点，技术难度很高，术后并发症发生率高，围手术期管理困难，目前在国内开展时间短，病例数量少，临床经验相对缺乏。目的：探讨婴幼儿肝移植术后近期并发症及其防治经验。方法：回顾性分析天津市第一中心医院2006-09/2010-01完成的14例婴幼儿肝移植临床资料，年龄6个月~2岁8个月，其中活体肝移植8例，劈离式肝移植6例。记录分析术前情况，手术方式，围手术期处理，术后一般情况，并发症情况等。结果与结论：14例婴幼儿肝移植术后早期有13例存活，1例患儿术后第5天因原葛西式手术吻合口溃疡穿孔致重度感染死亡；其他术后近期并发症依次包括：病毒感染6例次、腹腔感染3例次、胆道逆行性感染3例次、胆漏3例次、乳糜漏2例次、胆道吻合口狭窄1例次、急性排斥反应1例次、药物性精神症状2例次。结果表明婴幼儿肝移植术后近期并发症发生率较高，以感染及手术并发症为主，对其合理防治尤为重要。关键词：婴幼儿；肝移植；近期并发症；感染；防治

Early complications in infants following liver transplantation

BACKGROUND: Infant liver transplantation is difficult, with high postoperative complications and difficult perioperative management. Domestic clinical experience in liver transplantation lacks due to short application and small case. OBJECTIVE: To investigate the early complication of liver transplantation in infants and discuss the experiences in prevention and treatment methods. METHODS: From September 2006 to January 2010, 14 infants underwent liver transplantation in First Central Hospital of Tianjin, aged 6 months to 2 years and 8 months, including 1iving related liver transplantation in 8 cases and split liver transplantation in 6 cases. Preoperative condition, operation patterns, perioperative treatment, postoperative general condition and complications were recorded.RESULTS AND COCNLUSION: Of 14 cases undergoing liver transplantation, 1 case died from jejunum ulcer perforation leading to severe septic shock. Other early complications after operation included intraabdominal infection 3 man-times, virus infection 6 man-times, retrograde infection of biliary 3 man-times, chyle leakage 2 man-times, biliary leakage 3 man-times, biliary stricture 1 man-times, acute rejection 1 man-times, psychiatric symptom because of FK506 2 man-times. The early complication in infants after liver transplantation is high, especially infection and operative complications. Therefore, prevention and treatment are very important.