肝移植术后肝周大量积血危险因素分析及处置方法

目的 探讨肝移植术后肝周大量积血的危险因素及其治疗方法.方法 回顾性分析2004年3月至2007年4月第二军医大学东方肝胆外科医院胆道一科收治的117例同种异体原位肝移植患者的临床资料,采用单因素及多因素分析方法分析肝移植术后肝周大量积血的危险因素,总结肝移植术后肝周大量积血患者的临床表现及相应的治疗措施.结果 117例患者中围手术期死亡12例,故最终105例纳入本研究.105例患者中术后发生肝周大量积血9例(8.57％),以皮肤、巩膜黄染加重,全血白细胞计数及中性粒细胞比例短时间内显著升高,肝功能受损为典型临床表现.单因素分析结果显示术后肝周大量积血与患者上腹部手术史(P=0.001)、术前血红蛋白水平(P=0.031)、术前白细胞水平(P=0.001)、术前血小板水平(P＜0.001)、术后胆漏(P=0.001)相关;多因素分析结果显示上腹部手术史(P=0.008,OR=15.000)、术后胆漏(P=0.034,OR=20.770)是肝移植术后肝周大量积血的独立危险因素.结论 了解患者的既往腹部手术史、术中严格保护胆管血供,吻合确切,避免胆漏,是预防肝移植术后肝周大量积血的主要措施.肝周大量积血一旦产生,及时穿刺引流或手术清除积血是有效的治疗方法.

Risk factor analysis and management of massive perihepatic blood accumulation after liver transplantation

Object: To investigate the risk factors and the corresponding treatment methods of massive perihepatic blood accumulation after liver transplantation. Method: Clinical data of 117 patients in the first biliary tract surgery department , Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, from March 2004 to April 2007,which were performed orthotopic liver transplantation, were retrospectively studied to analyze the independent risk factors associated with the occurrence of massive perihepatic blood accumulation by univariate analysis and multivariate analysis, and to summarize the corresponding treatment methods. Result: In 117 cases, 9 cases (8.57%) had postoperative massive perihepatic blood accumulation. The typical clinical manifestation was as follows: yellow dye of sclera suddenly increased; white blood cell count and the percentage of neutrophils were significantly higher in a short time; Impaired liver function. 1) Univariate analysis: the massive perihepatic blood accumulation was associated with History of upper abdominal surgery (P=0.001), preoperative hemoglobin level (P=0.031), preoperative levels of white blood cell (P=0.001), preoperative platelet levels (P < 0.001), and postoperative bile leakage (P=0.001) 2) The logistic regression analysis: History of upper abdominal surgery (P=0.008, OR=15.000) and postoperative bile leakage (P=0.034, OR=20.770) were independent risk factors for massive perihepatic blood accumulation. Conclusion: The main methods to avoid massive perihepatic blood accumulation are to understand the history of upper abdominal surgery in patients, strictly protect the blood supply of bile duct, and anastomosis exactly. Puncture or operation timely is an effective treatment when massive perihepatic blood accumulation occurred.