肝移植后的并发症

背景：原位肝移植因其移植过程复杂，易产生各种并发症，制约着肝移植手术的成功率。目的：分析肝移植后并发症发生的常见原因及预防处理措施。方法：回顾性分析176例肝移植患者中出现并发症的59例患者的临床资料，男53例，女6例，年龄25—74岁，平均（46．41±12．02）岁。原发病中乙型肝炎后肝硬化10例（合并肾衰1例），肝硬化合并肝细胞性癌7例，胆汁性肝硬化4例，酒精性肝硬化1例，肝细胞性癌13例，胆管细胞癌1例，肝豆状核变性3例，肝功能衰竭13例，重型乙型病毒性肝炎7例（合并肾衰1例）。所有病例供、受者均符合血型相符原则。结果与结论：肝移植后发生并发症102例次，其中腹腔内出血15例，上消化道出血5例，肺部感染21例，腹腔感染5例，胆道并发症21例，慢性排斥3例，急性排斥10例，急性肾功能衰竭7例，乙肝复发3例，神经精神并发症6例，移植肝无功能4例，下腔静脉血栓形成、移植物抗宿主反应各1例。围手术期死亡24人，直接死亡原因腹腔出血6例，肺部感染6例，移植肝无功能4例，多器官功能衰竭3例，腹腔感染、移植物抗宿主、心脏骤停、胆管坏死、蛛网膜下腔出血各1例。提示重视肝移植患者围移植期的处理，改善肝功能、纠正凝血障碍、改善营养、控制感染，重视移植技术的完善和并发症的及时诊断处理，是提高肝移植成功率的关键。

Complications after liver transplantation

BACKGROUND： The complicated operation process and easy production of complications of orthotropic liver transplantation limit the successful rate of liver transplantation.OBJECTIVE： To investigate the common reasons and prevention and treatment of complications after liver transplantation. METHODS： Clinical data of 59 cases （53 males and six females） with complications in 176 liver transplantation patients were analyzed retrospectively, the age of the 59 patients were 25-74 years, averaged in （46.41 ±12.02） years. Ten cases had the parimary disease of hepatitis B cirrhosis （hepatitis B merger renal failure in one case）, seven cases had cirrhosis complicated hepatocellular carcinoma, four cases had biliary cirrhosis, one case had alcoholic cirrhosis, 13 patient had hepatocellular carcinoma, one case had cholangiocarcinoma, three cases had hepatolenticular degeneration, 13 patients had liver failure and 47 patients had severe hepatitis B （severe hepatitis B combined with renal failure in one case）. All the donors and recipients were in line with the principle of blood type matching. RESULTS AND CONCLUSION： A total of 102 cases of complications occurred, including abdominal cavity bleeding （15 cases）, upper gastrointestinal bleeding （five cases）, pulmonary infection （21 cases）, abdominal infection （five cases）, biliary complications （21 cases）, chronic rejection （three cases）, acute rejection （ten cases）, acute renal insufficiency （seven cases）, hepatitis B virus recurrence （three cases）, neuropsychopathic complications （six cases）, primary nonfunction （four cases）, inferior vena cava thrombosis （one case）, graft-versus-host reaction （one case）. A total of 24 patients died during perioperative period, abdominal cavity bleeding （six cases）, pulmonary infection （six cases）, primary nonfunction （four cases）, multiple organ dysfunction syndrome （three cases）, abdominal infection （one case）, graft-versus-host reaction （one case）, crdiac arrest （one case）, bUiary necrosis （one case）, subarachnoid hemorrhage （one case）. Emphasis on perioperative period management of liver transplantation patients, to improve the liver function, to correct the coagulation, to improve the nutrition and the infection control, as well as the improvement of surgical techniques and timely diagnosis and treatment of the complications are the keys to improve the success rate of liver transplantation.