儿童DCD供肝肝移植术后肝动脉并发症的诊治体会

发布时间：2018-07-03 11:36

本文选题：肝移植 + 婴幼儿　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:探讨进一步降低儿童DCD供肝肝移植术后肝动脉并发症的措施。方法:回顾性分析2011年7月至2014年4月我院完成的17例儿童DCD供肝肝移植临床资料。本组供肝符合DCD器官捐献标准,均由中国人体器官分配与共享系统(COTRS)分配。本组17例受者中胆道闭锁伴胆汁性肝硬化14例,原发性肝硬化失代偿1例,糖原累积症2例。术中14例供肝为全肝,1例供肝为左半肝,2例供肝为劈离肝,均无重要血管及胆道损伤。供体吻合动脉直径:0.2~0.5cm,受体吻合动脉直径:0.2~0.4cm。结果:术后6例发生肝动脉血栓(hepatic artery thrombosis,HAT),经介入或再次肝动脉吻合及微动脉插管持续尿激酶灌注后恢复供血,其中2例分别于术后21天及7天死于严重肺部肺炎克雷白杆菌感染,1例术后7天死于肝动脉血栓形成,1例术后5天死于严重毛细血管渗漏综合征,1例术后23天死于肠漏后感染性休克,1例术后1天死于因凝血功能严重障碍所致的失血性休克,其余11例顺利出院,健康生活至今。结论:儿童DCD供肝肝移植术后肝动脉血栓发生率较高,有效的选择肝动脉支进行吻合及良好的动脉吻合技术可以降低肝动脉血栓发生率,对肝动脉栓塞的可疑患者行剖腹探查、肝动脉介入造影检查及溶栓治疗可有效诊断和治疗肝动脉血栓。
[Abstract]:Objective: to study the measures to reduce the complications of hepatic artery after DCD donor liver transplantation in children. Methods: the clinical data of 17 children with DCD donor liver transplantation from July 2011 to April 2014 were analyzed retrospectively. The donor liver met the standard of DCD organ donation and was distributed by Chinese Human Organ Distribution and sharing system (COTRS). There were 14 cases of biliary atresia with biliary cirrhosis, 1 case of primary cirrhosis decompensation and 2 cases of glycogen accumulation. During the operation, 14 cases of donor liver were whole liver and 1 case of donor liver was left half liver. 2 cases of donor liver were split liver without important vessel and bile duct injury. The diameter of donor anastomosis artery was 0.5 cm, and that of recipient anastomosis artery was 0.2 ~ 0.2cm. Results: (hepatic artery thromboembolism was found in 6 patients after operation. After interventional or re-anastomosis of hepatic artery and continuous infusion of urokinase by arteriole, blood supply was restored. Two of them died of severe Klebsiella pneumoniae infection on 21 and 7 days, respectively. One died of hepatic artery thrombosis 7 days after operation, one died of severe capillary leakage syndrome on 5 days after operation, and one died 23 days after operation. One case of septic shock after intestinal leakage died of hemorrhagic shock caused by severe coagulation dysfunction 1 day after operation. The other 11 cases were discharged from hospital smoothly and have been living healthily so far. Conclusion: the incidence of hepatic artery thrombosis in children with DCD donor liver transplantation is high. The effective choice of hepatic artery anastomosis and good arterial anastomosis technique can reduce the incidence of hepatic artery thrombosis, and explore the suspected patients with hepatic artery embolism by laparotomy. Hepatic arteriography and thrombolytic therapy can effectively diagnose and treat hepatic artery thrombosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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