原位肝移植术后近期并发症的防治

目的：探讨原位肝移植术后并发症发生的常见原因、预防及处理措施。方法：回顾性分析我科近3年来所施行的72例原位肝移植病人术后并发症发生的种类及数量，以及诊治处理方法。结果：72例肝移植病人中，原发病为良性疾病50例（其中终末期乙肝肝硬变34例），恶性疾病22例（其中HCC19例）。术后发生并发症54例次，因凝血功能紊乱致术后腹腔内继发性出血4例，术前腹水感染未能控制致术后腹水严重感染2例，激素用量过大致应激性溃疡出血、穿孔1例，胆漏6例，肺部感染21例，肠道霉菌感染5例。全组无原发性肝无功能及血管并发症，随访2-41个月。无远期胆道并发症及慢排发生。住院期死亡6例，随访期死亡6例，目前生存60例，总生存率为80.33％，存活超过1年者32例，最长已3年5个月。结论：我国肝移植病人适应证以终末期乙肝肝硬化为主，这类病人肝功能不良，凝血障碍，围手术期凝血功能的纠正甚为重要，同时这类病人多存在营养不良，免疫功能低下，应重视围手术期感染的控制及营养支持。手术技术的完善是预防肝移植后血管并发症的关键。

The prophylaxes and treatment of postoperative complications in orthotopic liver transplantation

Objective To investigate the common reasons,prophylaxes and treatment of postoperative complications in orthotopic liver transplantation (OLT).Method Seventy two patients who underwent OLT during recent three years were collected and analyzed retrospectively.Results OLT was performed on 50 cases with benign diseases including terminal liver cirrhosis 34;and 22 cases with and malignant diseases including hepato cellular carcinoma 19 cases.Fifty four complications were occurred postoperatively,including secondary abdominal cavity bleeding (4 cases ),severe infection of ascites (2 cases),stress gastric ulcer with bleeding and perforation (1 cases),biliary leak (6 cases),pulmonary infection (21 cases),and enteric fungal infection (5 cases).There were no primary dysfunction of liver and vascular complications.Follow up 2-41 months, without biliary complications and chronic liver dysfunction occurred 6 cases death postoperative,6 cases death on follow-up period.Total surrival rate is 83.33%, 32 cases alive more than 1 year,the longest surrival cases is 41 months postoperative.Conclusions It is suggested that the cases with cirrhosis are main indication for liver transplantation.The patients with liver cirrhosis always combinated of liverdisfunction,coagulopaphy,malnutrition and poor immune functions and we should pay attention to replace that of coagulation factors,antibiotics using and nutrition support perioperatively.Good surgical technique is the key point for preventing vascular complications.