小儿肝移植近期并发症防治

目的探讨小儿肝移植术后管理经验以及近期并发症的防治。方法2001年11月至2003年12月行小儿肝移植7人8例次，其中亲体肝移植2例，减体积肝移植3例，劈离式肝移植2例。术后即送至ICU监护并监测重要脏器功能、凝血功能及生化指标，早期用免疫抑制剂和预防性应用抗生素，每日Doppler检查肝脏血流速度和频谱。结果1例术后第5d死于急性肾功能衰竭；其他近期并发症还包括：腹腔内大出血2例、门静脉栓塞1例、肝静脉狭窄1例、右上肺不张5例、成人呼吸窘迫综合征(ARDS)及肺炎2例、消化道出血3例、腹腔感染1例、伤口感染2例、病毒感染3例、肾功能损伤2例、胆道并发症2例、急性排斥反应2例。结论小儿可成功施行肝移植手术，然而，术后并发症的风险却不容忽视。

The early complications of liver transplantation in children

Objective To review the early complications of liver transplantation (LT) in children. Methods Between Nov. 2001 and Dec. 2003, seven children (8 times) underwent LT (living-related LT in 2 cases, reduced-size LT in 4, split LT in 2, and retransplantation in 1) in our institute. They were immediately transferred to ICU for custodial care and observation of coagulation and biochemistry. Immunosuppressants and antibiotics were prophylactically administered after operation. Recipients accepted Doppler examination for hepatic blood flow everyday. The early complications were recorded and analyzed. Results One recipient died of renal failure on the 5 th day of postoperation. Other postoperative complications included massive intraabdominal bleeding (n=2), portal vein thrombosis (n=1), hepatic vein stenosis (n=1), atelectasis of upper right lung (n=5), digestive tract bleeding (n=3), ARDS and pneumonia (n=2), intraabdominal infection (n=1), wound infection (n=2), viral infection (n=3), impaired renal function (n=2), bile duct complication (n=2), and acute rejection (n=2). Conclusion It is necessary to keep children under surveillance to prevent and manage the early complications of LT.