肝移植及术后并发症的处理(附18例报告)

目的探讨采用肝移植技术治疗肝脏终末期病变的方法及术后并发症的处理。方法对采用背驮式肝移植和经典的原位肝移植技术治疗18例肝脏终未期患者进行回顾性分析。结果本组无手术中死亡。18例患者(9例为终末期肝硬化,9例为肝细胞癌)术后出现19例次并发症(包括切口血肿、胸腔积液、脓液、肺炎、胆汁漏、严重胆管炎、急性排斥反应,感染性休克,多器官功能不良综合征等)。5例于术后1个月内死亡,死亡原因为肺部感染合并呼吸衰竭,急性肾功能衰竭,急性心功能衰竭,肝功能衰竭及感染性休克。术后随访3月～3年,9例仍然存活,后期死亡4例,其中2例死于肺炎并呼吸衰竭,另2例死于脑转移和肝癌复发。结论肝移植是治疗末期肝病的有效手段。为了肝移植能取得良好的疗效,合理选择肝移植的手术适应证,正确的围手术期及手术后合并症的处理是非常重要的。

Liver transplantation and management of the postoperative complications(A report of 18 cases)

Objective To investigate using the techniques of liver transplantation in the treatment of the end-stage liver diseases and management of postoperative complications. Methods 18patients with end-stage liver disease underwent piggy-back liver transplantation and classical orthotopic liver transplantation. Results In this group,no intraoperative death was found.Among18cases,the operative complications occurred19sample in18cases(including incisional hematoma,hydrothorax,empyema,pneumonia,biliary leakage,severe cholangitis,acute rejection,septic shock and MODS etc).Five cases died within one month after operation.They died from pulmonary infection associated with respiratory failure,acute renal failure,acute heart failure,acute hepatic failure and septic shock.With follow-up from3months to3years after operation,9cases were still survival.Death of anaphase had4cases,2cases died from pneumonia associated with respiratory failure,2cases died from cerebral metastasis and recurrence of liver cancer. Conclusion Liver transplantation is an effective method in the treatment of end-stage liver diseases.For taking a good efficacy on the liver transplantation,a reasonable operation indication of liver transplantation and a correct management of perioperative period and postoperative complications are very important.