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。

Diagnosis and treatment of liver abscess after orthotopic liver transplantation

Objective To investigate etiology,diagnosis,treatment and prophylaxis of liver abscess afterorthotopic liver transplantation (OLT). Methods Of 274 recipients of OLT from January 1993 to June 2003 in ourtransplant center, liver abscess were identified in 6 recipients (2.2%). The clinical presentation included fever, shiver,abdominal pain, jaundice, hepatic dysfunction, hypoalbuminemia, anemia, leukocytosis and neutrophilia. They werediagnosed mainly according to the clinical presentation and Ultrasonography or CT scan. The treatments includedaspiration and drainage of abscess, removing bile sludge, antibiotics and supportive therapy. Results Of 6 patients, 2were cured, 3 refused liver retransplantation and 2 died of serious systemic infection. The cure rate was 33.3%. Conclu-sions the etiology of liver abscess after OLT is complicated. The predisposing factors might be included hepatic arterythrombosis or stenosis, MP pulse therapy, cholangitis and biliary interventional therapy. Its prognosis seemed disappoiting.Strong prophylactic measures should be recommended to reduce the liver abscess after OLT.