肝移植术后肝周大量积血危险因素分析及处置方法

发布时间：2018-06-27 07:32

本文选题：肝移植 + 肝周大量积血　；参考：《第二军医大学学报》2017年07期

【摘要】：目的探讨肝移植术后肝周大量积血的危险因素及其治疗方法。方法回顾性分析2004年3月至2007年4月第二军医大学东方肝胆外科医院胆道一科收治的117例同种异体原位肝移植患者的临床资料,采用单因素及多因素分析方法分析肝移植术后肝周大量积血的危险因素,总结肝移植术后肝周大量积血患者的临床表现及相应的治疗措施。结果 117例患者中围手术期死亡12例,故最终105例纳入本研究。105例患者中术后发生肝周大量积血9例(8.57%),以皮肤、巩膜黄染加重,全血白细胞计数及中性粒细胞比例短时间内显著升高,肝功能受损为典型临床表现。单因素分析结果显示术后肝周大量积血与患者上腹部手术史(P=0.001)、术前血红蛋白水平(P=0.031)、术前白细胞水平(P=0.001)、术前血小板水平(P0.001)、术后胆漏(P=0.001)相关;多因素分析结果显示上腹部手术史(P=0.008,OR=15.000)、术后胆漏(P=0.034,OR=20.770)是肝移植术后肝周大量积血的独立危险因素。结论了解患者的既往腹部手术史、术中严格保护胆管血供,吻合确切,避免胆漏,是预防肝移植术后肝周大量积血的主要措施。肝周大量积血一旦产生,及时穿刺引流或手术清除积血是有效的治疗方法。
[Abstract]:Objective to investigate the risk factors and treatment of perihepatic hemorrhage after liver transplantation. Methods from March 2004 to April 2007, 117 patients with orthotopic liver transplantation (OLT) treated in Department of Biliary tract, Oriental Hepatobiliary surgery Hospital, second military Medical University, were retrospectively analyzed. Single factor and multivariate analysis were used to analyze the risk factors of massive perihepatic hemorrhage after liver transplantation, and to summarize the clinical manifestations and corresponding treatment measures of patients with massive perihepatic hemorrhage after liver transplantation. Results among the 117 patients, 12 died during perioperative period, so 105 cases were included in this study. 9 cases (8.57%) developed massive perihepatic hemorrhage after operation, which was aggravated by yellow stain of skin and sclera. The whole blood leukocyte count and neutrophil ratio increased significantly in a short period of time, and liver function impairment was a typical clinical manifestation. Univariate analysis showed that postoperative perihepatic hemorrhage was correlated with the history of upper abdominal surgery (P0. 001), preoperative hemoglobin level (P0. 031), preoperative leukocyte level (P0. 001), preoperative platelet level (P0. 001) and postoperative biliary leakage (P0. 001). Multivariate analysis showed that the history of epigastric surgery (P0. 008) and postoperative bile leakage (P0. 034) were independent risk factors for massive perihepatic hemorrhage after liver transplantation. Conclusion to understand the history of previous abdominal surgery, to protect the blood supply of bile duct strictly, to anastomose accurately and to avoid bile leakage are the main measures to prevent massive perihepatic hemorrhage after liver transplantation. Once a large amount of perihepatic hemorrhage is produced, puncturing and drainage in time or surgical removal of hemorrhage is an effective treatment.
【作者单位】：第二军医大学东方肝胆外科医院胆道一科;第二军医大学东方肝胆外科医院腹腔镜科;第二军医大学东方肝胆外科医院胆道三科;
【基金】：上海市科委重点基础项目(03JC14002)~~
【分类号】：R657.3

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