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肝移植过程中合并小肠坏死2例
引用本文:谢占涛,孙建军,赵会博,汤高枫,魏思东,陈永峰,徐化恩,李彩丽,陈国勇. 肝移植过程中合并小肠坏死2例[J]. 中国组织工程研究, 2013, 17(44): 7715-7720. DOI: 10.3969/j.issn.2095-4344.2013.44.010
作者姓名:谢占涛  孙建军  赵会博  汤高枫  魏思东  陈永峰  徐化恩  李彩丽  陈国勇
作者单位:郑州人民医院肝胆胰腺外科,河南省郑州市 450003
摘    要:背景:肝移植过程中合并肠坏死发生率低,并且多放弃手术治疗导致患者死亡。目的:回顾性分析肝移植过程中合并小肠坏死的常见原因,探讨可行的治疗方案。方法:总结207例肝移植患者资料,其中2例患者肝移植过程中发现小肠坏死,病例1行肝移植联合坏死小肠切除,病例2放弃肝移植,保守治疗。结果与结论:2例患者移植前均存在门脉系统血栓。病例1患者移植前上消化道出血,反复止血药物应用加重血栓,进而导致肠坏死发生。患者肝移植后第10天发现肠瘘,行造瘘术。造瘘术后患者合并腹腔、肺部感染。抗感染治疗并停用免疫抑制剂7 d后感染控制。造瘘术后40 d肠瘘愈合,康复出院。目前,随访两年余患者健康生存;病例2移植前大量腹水导致腹腔间室综合征发生,肠道静脉回流障碍导致广泛小肠坏死。放弃肝移植后第2天,患者因多脏器功能衰竭死亡。可见等待肝移植患者,如移植前存在门脉系统血栓,合并腹痛、腹胀等症状时,需警惕肠坏死发生;肝移植过程中如发现小肠坏死,可行肝移植联合坏死小肠切除,患者可获得良好预后。

关 键 词:器官移植  肝移植  肠坏死  肝移植联合坏死小肠切除  肝小肠联合移植  

Two cases of small bowel necrosis during liver transplantation
Xie Zhan-tao,Sun Jian-jun,Zhao Hui-bo,Tang Gao-feng,Wei Si-dong,Chen Yong-feng,Xu Hua-en,Li Cai-li,Chen Guo-yong. Two cases of small bowel necrosis during liver transplantation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(44): 7715-7720. DOI: 10.3969/j.issn.2095-4344.2013.44.010
Authors:Xie Zhan-tao  Sun Jian-jun  Zhao Hui-bo  Tang Gao-feng  Wei Si-dong  Chen Yong-feng  Xu Hua-en  Li Cai-li  Chen Guo-yong
Affiliation:Department of Hepatobiliary Pancreatic Surgery, People’s Hospital of Zhengzhou, Zhengzhou  450003, Henan Province, China
Abstract:BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in small intestinal necrosis during liver transplantation, and to explore the viable treatment options.METHODS:The clinical data of 207 patients were reviewed, two patients complicated with small intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic small bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment.RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting small intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After followed-up for 2 years, the patient was still healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive small bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with small bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic small bowel resection.
Keywords:liver transplantation  intestine   small  enterocolitis   necrotizing  portal vein  
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