【摘要】 目的总结儿童肝移植的手术经验和术后并发症情况。方法回顾性分析2000年1月至2015年10月四川大学华西医院实施肝移植术的88例儿童患者临床资料。其中男38例,女50例;年龄3个月~17岁7个月,中位年龄2岁3个月。活体肝移植77例,尸体肝移植11例。左半肝移植39例,左外叶肝移植49例。术后主要免疫抑制方案为肾上腺皮质激素+他克莫司(FK506)或环孢素,术后应用肝素抗凝治疗。所有患者及其家属均签署知情同意书,符合医学伦理学规定。观察患者的术中情况、术后并发症发生情况。结果本组患者的平均手术时间为(7.5±2.4)h,术中出血量中位数475(100~2 000)ml,输注红细胞1.8(0~6.5)U,热缺血时间2.5(1.0~10.0)min,冷缺血时间188(110~590)min,下腔静脉阻断时间75(35~170)min。患者术后发生早期并发症49例,其中血管并发症发生率11%(10/88),包括肝动脉血栓形成4例,门静脉血栓形成5例,肝静脉狭窄1例;晚期并发症16例,其中胆道并发症发生率12%(11/88),包括胆管炎9例,胆漏、胆管狭窄各1例。患者术后1、3年生存率分别为81%、75%。结论近年来儿童肝移植的手术成功率及术后生存率均有明显提高,但术后血管和胆道并发症发生率仍较高,应不断改进手术方式,个体化调整免疫抑制剂、抗凝等治疗方案以取得更好疗效。更多还原

【Abstract】 Objective To summarize the operative experiences and postoperative complications of pediatric liver transplantation(LT). Methods Clinical data of 88 child patients undergoing LT in West China Hospital, Sichuan University between January 2000 and October 2015 were retrospectively analyzed. Among the patients, 38 were males and 50 were females, with the age ranging from 3 months to 17 years and 7 months old and the median of 2 years and 3 months old. Seventy-seven cases underwent living donor LT and 11 underwent cadaver LT. Thirty-nine cases underwent left lobe transplantation and 49 underwent left lateral lobe transplantation. The main immunosuppressive regimen after operation was adrenocortical hormone + tacrolimus(FK506) or cyclosporin. And heparin was used after operation for anticoagulation. The informed consents of all patients and their families were obtained and the local ethical committee approval was received. The intraoperative conditions and postoperative complications of the patients were observed. Results The average operation time was(7.5±2.4) h, the median intraoperative blood loss was 475(100-2 000) ml, the transfusion of red blood cells was 1.8(0-6.5) U, the warm ischemia time was 2.5(1.0-10.0) min, the cold ischemia time was 188(110-590) min and the inferior vena cava occlusion time was 75(35-170) min. Forty-nine cases developed early complications after operation, and the incidence of vascular complications was 11%(10/88), including 4 cases of hepatic artery thrombosis, 5 of portal vein thrombosis and 1 of hepatic vein stenosis. Sixteen cases developed late complications, and the incidence of biliary complications was 12%(11/88), including 9 cases of cholangitis, 1 of bile leakage and 1 of bile duct stricture. The 1-, 3-year survival rate after LT was respectively 81% and 75%. Conclusions The success rate and postoperative survival rate of pediatric LT have increased signifi cantly in recent years. However, the incidence of postoperative vascular and biliary complications are still high. Thus, the operation procedures should be kept improving, and the immunosuppressant and anticoagulant therapy should be individually adjusted in order to obtain better effi cacy.更多还原