心脏死亡供肝肝移植术后并发移植肝大范围坏死分析

发布时间：2019-03-23 16:00

【摘要】：目的探讨心脏死亡供肝肝移植术后的并发症和应对措施。方法回顾分析同济医院2013年12月至2015年11月期间的24例心脏死亡供肝肝移植病例资料,观察患者术后的恢复情况,并总结对术后并发症的治疗原则。结果术后谷草转氨酶和谷丙转氨酶峰值的均值分别为1 951U/L和962U/L。患者住院时间(22±5)d(10~35d)。住院期间共发生常规术后并发症6例(25.0%),死亡1例(4.2%),无原发性无功能发生,但是术后1周的增强CT检查发现了一种新的并发症——移植肝大范围坏死,共4例(16.7%)。对肝坏死患者采取保证肝脏灌注、减轻炎症反应、避免药物肝毒性和预防肝坏死后感染的治疗原则,术后20~28d复查CT示移植肝坏死灶已修复或消失。结论心脏死亡供肝损伤较严重时,容易发生移植肝大范围坏死。在正确诊断和积极治疗的基础上,移植肝坏死是可能完全修复的,由此可能部分降低原发性无功能的发生。
[Abstract]:Objective to investigate the complications and countermeasures after liver transplantation with cardiac death donor. Methods the data of 24 cases of liver transplantation with cardiac death from December 2013 to November 2015 in Tongji Hospital were retrospectively analyzed. The postoperative recovery was observed and the principles of treatment for postoperative complications were summarized. Results the peak values of glutamic-oxaloacetic transaminase and glutamic-pyruvic transaminase were 1 951U/L and 962 U / L, respectively. The length of hospital stay was (22 卤5) d () 10 days (35 days). During hospitalization, complications occurred in 6 cases (25.0%) and death occurred in 1 case (4.2%). There was no primary failure to function. However, one week after operation, enhanced CT showed a new complication-massive necrosis of transplanted liver. There were 4 cases (16.7%). To ensure hepatic perfusion, reduce inflammatory reaction, avoid drug hepatotoxicity and prevent infection after liver necrosis in patients with liver necrosis, CT examination showed that the graft necrotic foci had been repaired or disappeared on the 28th day after operation. Conclusion large-scale necrosis of transplanted liver is easy to occur when cardiac death and donor liver injury is serious. On the basis of correct diagnosis and active treatment, graft liver necrosis may be completely repaired, which may partly reduce the occurrence of primary infunction.
【作者单位】：华中科技大学同济医学院附属同济医院器官移植研究所;华中科技大学同济医学院附属同济医院教育部/卫生计生委器官移植重点实验室;华中科技大学同济医学院附属同济医院肝脏外科;中国人民解放军96763部队医院;湖北医药学院药护学院;
【基金】：国家卫生计生委卫生行业科研专项项目(No.201302009) 国家自然科学基金资助项目(No.81373168) 国家重点基础研究发展计划子课题(No.2013CB530803)
【分类号】：R657.3

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