肝移植术后高胆红素血症的鉴别诊断

目的 探讨肝移植术后高胆红素血症的发生规律和特点，提高鉴别诊断和治疗的正确率，方法 总结5例肝移植术后高胆红素血症的发生频度、诊断和治疗效果，分析导致高胆红素血症的各种可能因素，提出鉴别诊断的要点。结果 5例肝移植共经历了11次高胆红素血症，其中急性排斥反应3例，肝内胆汁淤滞2例，胆总管内支撑物堵塞、CsA毒性反应以及肝动脉血栓形成各1例，均及时诊断并治愈，肝外胆道进行性狭窄、慢性排斥反应、供肝原发性无功能、以及乙肝复发各1例次，由于未能及时诊断导致治疗失败。结论 高胆红素血症是肝移植术后常见并发症，原因和机理错综复杂。了解肝移植术后恢复过程的规律，根据胆红素升高的时间，辅助检查结果以及病理学所及时作出正确诊断，是治疗成功的关键。

Differential diagnosis of bilirubinemia after liver transplantation

Objective To investigate the occurring rule and characteristics of bilirubinemia after liver transplantation to improve proper rate of differential diagnosis and treatment.Methods The frequency of occur- rence,diagnoses and the effect of treatment were retrospectively studied in 5 cases of liver transplantation with the complication of bilirubinemia.The factors inducing the bilirubinemia were analyzed and the key points of differen- tial diagnosis posed.Results Five patients experienced 11 times of bilirubinemia including 3 cases of acute rejec- tion,2 cases of intrahepatic cholestases,1 case ofT tube obstruction and 1 case of CsA toxicity.All the patients were cured with timely diagnosis and treatment.However,the treatments failed for progressive stricture in extro- hepatic bile duct,chronic rejection,primary nonfunction in donor liver and the recurrence of HBV because the di- agnoses were not made in time.Conclusions Bilirubinemia is a common complication after liver transplantation and its reasons and mechanism are complicated.The key point for successful treatment is to study the recovery pro- cess after the liver transplantation and to have a proper diagnosis according to the raising time of bilirubin,results of supplementary examinations and pathological findings.