同种异体肝脏移植手术后早期胸腹腔出血的处理

目的：总结同种异体肝脏移植手术后早期胸腹腔出血的病因、临床表现及处理对策。方法：对2000年8月－2002年1月12例同种异体肝脏移植手术后早期发生胸腹腔出血病人的资料，分析出血原因、早期临床表现、处理方法、病人的转归，探讨对此类病人的治疗对策。结果：12例中最常见的出血原因是早期腹腔手术创面的渗血，其次为肝动脉溶栓后引起的腹腔出血，出血量均较大。12例病人中6例接受了二次开腹止血手术，5例发生急性肾功能衰竭。12例病人中4例死亡，其中3例死亡原因与肾功能衰竭直接有关。结论：原位肝移植手术后早期胸腹腔出血的发生率较高，二次开腹止血要果断、准确、积极，输血和使用止、凝血药物时，应注意肾脏功能的保护。

Strategy of management for bleeding in thorax and abdominal cavity in the early stage of postorthotopic of orthotopic liver transplantation

Objective:To investigate the common reasons,clinical features and the strategy of management with postoperative bleeding in thorax and abdominal cavity in orthotopic liver transplantation(OLT).Methods:Data based on the 12 cases undergoing OLT in our hospital from August 2000 to January 2002 were collected and analyzed.Results:The most common reason for bleeding post OLT was staxis in abdominal cavity(n=5),then was as followed:the abdominal bleeding caused by hepatic artery thrombolytic therapy(n=3),liver biopsy(n=2),Tipps(n=1),surgical technical reason(n=1).In all 12 cases,re operation of laparotomy was needed in 6 because of the massive bleeding.Acute renal failure happened in 5,and 3 needed hemodialysis.Four patients died postoperatively from massive abdominal bleeding,and 3 caused directly by the acute renal failure.Conclusion:Bleeding in the thorax and abdominal cavity happens frequently after OLT,and staxis in abdominal is the most common reason.The correct management for bleeding is the key thing to prevent complications.It is important to pay close attention to perioperative improvement of coagulative capacity,control of massive bleeding and prevention of renal failure.