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| 肝移植术后肝周大量积血危险因素分析及处置方法 |
| 邱智泉1,谭蔚锋2,罗祥基3,易滨1,刘刚2,钱波2,刘辰1,张柏和1,姜小清1* |
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(1. 第二军医大学东方肝胆外科医院胆道一科, 上海 200438;
2. 第二军医大学东方肝胆外科医院腹腔镜科, 上海 200438;
3. 第二军医大学东方肝胆外科医院胆道三科, 上海 200438
*通信作者) |
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| 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（P<0.001）、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。 |
| 关键词: 肝移植 肝周大量积血 危险因素 疾病管理 |
| DOI：10.16781/j.0258-879x.2017.07.0933 |
| 投稿时间：2016-12-23修订日期：2017-03-14 |
| 基金项目:上海市科委重点基础项目（03JC14002）. |
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| Risk factor analysis and management of massive perihepatic blood accumulation after liver transplantation |
| QIU Zhi-quan1,TAN Wei-feng2,LUO Xiang-ji3,YI Bin1,LIU Gang2,QIAN Bo2,LIU Chen1,ZHANG Bai-he1,JIANG Xiao-qing1* |
(1. Department of Biliary Tract Surgery(Ⅰ), Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;
2. Department of Laparoscopic, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;
3. Department of Biliary Tract Surgery(Ⅱ), Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To explore the risk factors and to develop the management methods of massive perihepatic blood accumulation after liver transplantation. Methods Clinical data of 117 patients, who received performed orthotopic liver transplantation in the Department of Biliary Tract Surgery (Ⅰ) of Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Mar. 2004 to Apr. 2007, were retrospectively studied to analyze the independent risk factors associated with the occurrence of massive perihepatic blood accumulation by univariate analysis and multivariate analysis, and to summarize the corresponding treatment methods. Results Twelve of 117 cases died in the perioperative period, and 105 cases were included in this study. Among 105 cases, 9 (8.57%) had postoperative massive perihepatic blood accumulation accompanied by aggravated yellowing of the skin and sclera, elevated whole blood leukocyte count and neutrophil proportion in a short period of time, and impaired liver function. Univariate analysis showed the massive perihepatic blood accumulation was associated with a history of upper abdominal surgery (P=0.001), pre-operative hemoglobin (P=0.031), pre-operative leukocyte count (P=0.001), pre-operative platelet count (P<0.001) and post-operative bile leakage (P=0.001); Multivariate analysis showed a history of upper abdominal surgery (P=0.008, OR=15.000) and post-operative bile leakage (P=0.034, OR=20.770) were independent risk factors for massive perihepatic blood accumulation. Conclusion The main methods to prevent massive perihepatic blood accumulation include knowing the history of upper abdominal surgery in patients, strictly protecting the blood supply of bile duct, accurate anastomosis and preventing bile leakage. Puncture or removal of hematocele timely is effective for massive perihepatic blood accumulation. |
| Key words: liver transplantation massive perihepatic blood accumulation risk factors disease management |
