Analysis of postoperative complications after autologous liver transplantation in hepatic alveolar echinococcosis patients from plateau area
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摘要:
目的 分析高原肝泡状棘球蚴病(HAE)自体肝移植术后常见的并发症。 方法 回顾性分析6例行离体或半离体病肝切除+自体肝移植术的晚期HAE患者的临床资料。分析其主要术后并发症的特点。 结果 HAE肝移植术后并发症主要包括胆道并发症(4例)、腹腔出血(1例)、感染(3例),其中2例患者发生胆漏并腹腔感染,因感染性休克、多脏器功能衰竭死亡;1例患者出现腹腔出血,因失血性休克、弥散性血管内凝血死亡。胆道并发症和腹腔出血是导致患者死亡的主要原因。 结论 胆道并发症、腹腔出血、感染等术后并发症是影响HAE自体肝移植术患者预后的主要因素。 Abstract:Objective To analyze common postoperative complications after autologous liver transplantation in patients diagnosed with hepatic alveolar echinococcosis (HAE) from plateau area. Methods Clinical data of 6 patients with advanced HAE undergoing ex-situ or partially ex-situ hepatectomy combined with autologous liver transplantation were retrospectively analyzed. Clinical characteristics of postoperative complications were analyzed. Results Postoperative complications mainly included biliary tract complications (n=4), intra-abdominal hemorrhage (n=1), infection (n=3). Two cases presented with bile leakage complicated with intra-abdominal infection and died from infectious shock and multiple organ dysfunction syndrome. One patient had intra-abdominal hemorrhage and died from hemorrhagic shock and disseminated inravascular coagulation. Biliary tract complication and intra-abdominal hemorrhage were primary causes of mortality. Conclusions Biliary tract complication, intra-abdominal hemorrhage and infection are the main prognostic factors for HAE patients undergoing autologous liver transplantation. -
表 1 6例晚期HAE患者的一般资料
Table 1. General information of 6 patients with advanced HAE
序号 性别 民族 年龄 (岁) 病程 (月) Child- Pugh分级 PNM分期 临床表现 腹痛 黄疸 下肢水肿 1 女 藏 19 24 A P3N1M0 + - - 2 女 汉 62 18 A P2N1M0 + - + 3 男 汉 50 10 B P2N1M0 + - - 4 男 汉 45 14 A P4N1M0 - + - 5 女 藏 37 20 A P4N1M0 + + - 6 男 藏 21 10 A P4N1M0 + + - 表 2 6例晚期HAE患者的手术情况
Table 2. Operation situation of 6 patients with advanced HAE
序号 手术方式 无肝期 (min) 病灶大小 (cm×cm×cm) 术中出血量 (ml) 术中输血量 手术时间 (min) 患者 预后 悬浮红细胞(U) 血浆(ml) 1 离体病肝切除+ 自体肝移植 273 20×20×15 600 4 600 546 存活 2 离体病肝切除+ 自体肝移植 366 16×13×10 3 500 8 1 300 729 死亡 3 离体病肝切除+ 自体肝移植 451 18×16×15 11 000 39 4 300 964 死亡 4 离体病肝切除+ 自体肝移植 187 18×15×12 3 000 6 950 607 死亡 5 半离体病肝切除+ 自体肝移植 0 16×15×10 6 000 20 2 730 693 存活 6 半离体病肝切除+ 自体肝移植 0 12×10×8 3 000 20 2 060 663 存活 -
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