急诊肝移植术治疗食管曲张静脉破裂出血

目的评价急诊肝移植术治疗食管曲张静脉破裂出血降门脉压力效果和围手术期安全性。方法回顾本中心自2004年9月~2005年10月急诊肝移植术治疗食管曲张静脉破裂出血的8例病人的临床资料。对比术前、术后门静脉压力(PVP)、脾脏斜径、门静脉(PV)血流速以及术后有无再次出血,评估降门脉压力效果。以术中、术后的并发症和死亡率发生情况评估安全性。结果手术成功率100%,术中失血量平均2 846 mL(1 200~4 800 mL)。所有病例移植肝开放后PVP明显降低(P<0.0001),脾脏斜径变化不明显(P>0.05),PV血流速改变与术前门静脉有无栓塞有关。术后1例出现上消化道再出血;4例出现肾功能衰竭继而肺部感染,其中1例抢救成功,3例(术前肝功能Child C级)均于术后2周内死亡。结论急诊肝移植术治疗食管曲张静脉破裂大出血,能有效降低门脉压力而控制出血,但对于肝功能Child C级同时有合并症的病例需选择更合适的手术时机。

Emergent Liver Transplantation for Active Esophageal Variceal Hemorrhage

Objective To evaluate the effectiveness to decompress portal system and the reliability during perioperation for patients with esophageal variceal hemorrhage treated by emergent liver transplantation. Methods The clinical data of eight patients with variceal hemorrhage secondary to portal hypertension who received emergent liver transplantation from September 2004 to October 2005 in our center were reviewed.Decompression was evaluated by comparison of pre-and post-operative portal venous pressure(PVP),spleen size,portal venous velocity and postoperative hemorrhage.The safety was examined by the morbidity and mortality. Results All patients survived the operations with the average blood loss of 2 846 mL(1 200 to 4 800 mL).Significantly decreased PVP(P<0.0001) strongly indicated effective decompression by transplantation,whereas the other parameters failed to assess the effectiveness.Only one rebleeding occurred.Four patients complicated with acute renal failure followed by pulmonary infection,among whom one survived by emergent treatment while the rest with Child C grade sacrificed within two weeks. Conclusion For patients with active esophageal variceal hemorrhage,emergent liver transplantation could be an effective and rescue therapy.However,those with worse liver function of Child C grade and other complications should be more cautious to choose the better timing of operation.