中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (53): 9893-9896.doi: 10.3969/j.issn.1673-8225.2011.53.004

• 肝移植 liver transplantation • 上一篇    下一篇

成人肝移植后的上消化道出血

朱志东，杜国盛，石炳毅，宋继勇，郑德华，崔洪涛   

  1. 解放军第309医院全军器官移植中心肝胆外科，北京市  100091
  • 收稿日期:2011-09-07 修回日期:2011-10-03 出版日期:2011-12-31 发布日期:2011-12-31
  • 作者简介:朱志东★，男，1967年生，山西省大同市人，1990年解放军第三军医大学毕业，硕士，长期从事肝胆、普外工作，专业特长为肝脏移植。 zzd309@sina.com

Upper gastrointestinal bleeding after adults orthotopic liver transplantation

Zhu Zhi-dong, Du Guo-sheng, Shi Bing-yi, Song Ji-yong, Zheng De-hua, Cui Hong-tao   

  1. Department of Hepatobiliary Surgery, Center of Organ Transplantation, the 309 Hospital of Chinese PLA, Beijing  100091, China
  • Received:2011-09-07 Revised:2011-10-03 Online:2011-12-31 Published:2011-12-31
  • About author:Zhu Zhi-dong★, Master, Department of Hepatobiliary Surgery, Center of Organ Transplantation, the 309 Hospital of Chinese PLA, Beijing 100091, China zzd309@sina.com

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549

被引次数

1

摘要：

背景：上消化道出血是肝移植后较为常见的并发症之一，国外报道发生率可达8.9%，国内报道为5%左右。
目的：总结原位肝移植后上消化道出血的原因及处理方法。
方法：回顾性分析412例肝移植后上消化道出血病例的临床资料，分析其可能的原因，处理及对肝移植预后的影响。
结果与结论：发生上消化道出血16例，均发生在移植后2个月内，其中胃、十二指肠溃疡、炎症出血8例，胃底、食道静脉曲张破裂出血4例，胆道出血4例，死亡4例。出血诱因为急性排斥反应应用大剂量皮质激素、严重感染、胆瘘，肝动脉假性动脉瘤形成，经皮肝穿胆管引流，肝穿活检等。8例经内科治疗后止血成功，3例介入治疗止血成功，1例开腹手术止血成功。说明消化性溃疡出血是肝移植后上消化道大出血的最常见原因，曲张静脉破裂出血和胆道出血次之；一经明确诊断应立即给予合理的治疗，并应根据患者移植前情况给予积极的预防措施。

关键词: 上消化道出血, 原位肝移植, 消化性溃疡, 肝动脉假性动脉瘤, 介入治疗

Abstract:

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is one of the more common complications in liver transplantation, the incidence of reported abroad was up to 8.9% and of reported domestic was 5%.
OBJECTIVE: To investigate the causes and treatment methods of UGIB after adult orthotopic liver transplantation.
METHODS: Totally 412 patients with UGIB after orthotopic liver transplantation was retrospectively reviewed. The bleeding causes and effect of hemostatic process on patient and grafts survival were analyzed.
RESULTS AND CONCLUSION: Totally 16 cases were subjected to UGIB during the first postoperative two months, including 8 cases with gastroduodenal ulcers bleeding, 4 cases with gastric fundus and esophagus variceal bleeding, 4 cases with hemobilia and 4 cases were dead. Bleeding inducements included that application of high-dose corticosteroids in acute rejection, serious infections, biliary fistula, hepatic artery pseudoaneurysm formation, percutaneous transhepatic biliary drainage, liver biopsy and so on. Eight cases underwent successful hemostasis by medical treatment, three cases underwent successful intervention treatment and one case underwent successful hemostasis by laparotomy. Peptic ulcers is the most common causes of UGIB following orthotopic liver transplantation, variceal bleeding and hemobilia are the second. After definite diagnosis, reasonable treatment should be immediately received, and active preventive measures should be also given to the patients according to the situation before transplantation.

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