中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (40): 7596-7600.doi: 10.3969/j.issn.2095-4344.2012.40.032

• 器官移植综述 organ transplantation review • 上一篇    

肝癌并门静脉血栓肝移植：难控制出血的一期血管吻合和二期胆肠吻合

陈 凯，赵 冀，邓小凡，张 宇，杨洪吉   

  1. 四川省医学科学院四川省人民医院器官移植中心，四川省成都市 610072
  • 收稿日期:2012-01-01 修回日期:2012-03-26 出版日期:2012-09-30 发布日期:2012-09-30
  • 通讯作者: 杨洪吉，硕士生导师，主任医师，四川省医学科学院四川省人民医院器官移植中心，四川省成都市 610072 hongji-yang65@126.com
  • 作者简介:陈凯★，男，1977年生，四川省宜宾县人，汉族，泸州医学院在读硕士，主治医师，主要从事肝胆胰外科方面的研究。 ckai0827@163. com

Orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis: Refractory bleeding treated with stage Ⅰ vascular anastomosis plus stage Ⅱ biliary-enteric anastomosis

Chen Kai, Zhao Ji, Deng Xiao-fan, Zhang Yu, Yang Hong-ji   

  1. Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
  • Received:2012-01-01 Revised:2012-03-26 Online:2012-09-30 Published:2012-09-30
  • Contact: Yang Hong-ji, Master’s supervisor, Chief physician, Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China hongji-yang65@126.com
  • About author:Chen Kai★, Studying for master’s degree, Attending physician, Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China ckai0827@163.com

PDF

508

摘要：

背景：原位肝移植过程中常出现难控性出血，止血困难，手术失败率高，但对其有效的处理手段目前尚未报道。
目的：探讨一期血管吻合、纱布压迫止血术式处理在肝癌并门静脉血栓肝移植中发生难控制出血的有效性，以及行二期胆肠吻合分期完成肝移植的可行性。
方法：对1例肝癌并门静脉血栓肝移植过程中出现难控制出血患者，采用一期血管吻合、纱布压迫止血，二期胆肠吻合术式进行止血处理，并观察该患者手术止血有效性以及肝移植术后恢复情况。
结果与结论：该患者行一期血管吻合，纱布填塞压迫止血后2 d出血停止，肝功能，凝血功能明显改善；二期胆肠吻合后未出现明显急性排异反应，3 d时肝功能、凝血功能明显改善；门静脉彩超示门静脉主干及分支管腔通畅灌注良好；移植后1周左右出现少尿、肾功能损害、大量腹水等肝肾综合征的表现，给予特利加压素等治疗后逐渐恢复；移植后2周出现因应激性溃疡导致上消化道出血，经内科止血治疗后治愈，于移植后34 d痊愈出院。结果表明，肝癌并门静脉血栓肝移植难控制出血，采用一期血管吻合、纱布压迫止血进行止血是有效的，并行二期胆肠吻合分期完成肝移植是完全可行的。

关键词: 难控性出血, 原位肝移植, 肝癌, 胆肠吻合, 血管吻合, 器官移植

Abstract:

BACKGROUND: Refractory bleeding often occurred in orthotopic liver transplantation, with difficultly treatment and high operation failure rate, but its effective means for the treatment was not yet reported today.
OBJECTIVE: To investigate the effectiveness of surgical approach with stage Ⅰ vascular anastomosis and gauze packing hemostasis for the treatment of refractory bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis, and the feasibility of plus stage Ⅱ biliary-enteric anastomosis completed orthotopic liver transplantation in stage.
METHODS: One patient with refractory bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis was treated with stage Ⅰ vascular anastomosis, gauze packing hemostasis and stage Ⅱ biliary-enteric anastomosis. In this study, we observed the effectivity of this hemostasis and recovery after liver transplantation.
RESULTS AND CONCLUSION: In this study, the bleeding was stopped at 2 days after treated with stage Ⅰ vascular anastomosis and gauze packing hemostasis, and the liver function and coagulation function were improved significantly; acute rejection after stage Ⅱ biliary-enteric anastomosis was not obvious, and liver function and coagulation function were improved significantly at 3 days after transplantation. Ultrasonography of the portal vein showed that the lumen of the main portal vein and its branches open and perfusion well. Hepatorenal syndromes such as oliguria, massive ascites and impaired renal function happened at 2 weeks after transplantation. And the hepatorenal syndromes were then gradually restored after treated with Terlipressin. Upper gastrointestinal bleeding caused by stress ulcer was appeared at 2 weeks after transplantation, and cured by the mediccal hemostatic treatment. The patient was discharged at 34 days after treatment. The results of this study show that stage Ⅰ vascular anastomosis and gauze hemostasis hemostasis are effectiveness for the treatment of refractory
bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis, and plus stage Ⅱ biliary-enteric anastomosis is entirely feasible to complete orthotopic liver transplantation in stage.

中图分类号: