肝移植术后再次手术分析：附14例报告

目的总结肝移植术后因外科并发症行再次手术治疗的经验。方法对近4年余治疗的200余例肝移植患者中14例17例次术后再次手术患者的临床资料进行回顾性分析。结果17例次再手术（包括再次肝移植1例）治疗肝移植术后外科并发症或其他合并症，手术成功率为100％。14例中1例因腹腔内出血于再次术后10d死于肾衰竭并发ARDS，1例因胸穿后血胸于再次术后20d死于严重的腹腔和肺部感染；1例因左肝内胆管结石伴胆道感染于再次术后33d死于多器官衰竭；1例因肿瘤复发转移于再次术后25d死亡；其余10例存活至今且肝功能良好，生存率71．4％（10／14）。结论准确把握肝移植术后外科并发症的再次手术时机，积极手术干预是提高肝移植成功率和移植后生存质量的关键。

Analysis of reoperations after orthotopic liver transplantation: a report of 14 cases

Objective To explore the clinical experience of treating the postoperative complications of orthotopic liver transplantation(OLT) by reoperation.Methods A retrospective analysis of the clinical data of over 200 OLT performed in Fuzhou General Hospital from June 2002 to March 2007 was made.Among 14 cases,17 reoperations(including 1 liver retransplantation) were performed.Results All of the 17 reoperations were performed to treat complications after liver transplantation.The reoperation success rate was 100%.Four patients died at 10th,20th,33rd,and 25th day respectively after reoperation.One case with intra-abdominal bleeding died of renal failure combined with adult respiratory distress syndrome(ARDS).One case with hemothorax after thoracocentesis died of severe abdominal cavity and lung infection.One case of hepatico stones and cholangitis died of multiple organ failure(MOF).One died of recurrence and metastasis of carcinoma.The other 10 patients survived with good liver function.Survival rate was 71.4%(10/14).Conclusions The key to improve the success rate of liver transplantation and quality of life after thansplantation is to correctly select the opportune time of reoperation for surgical complications after liver transplantation and make active surgical intervention.