【作者】 刘敏；

【导师】 康权；

【作者基本信息】 重庆医科大学 ， 儿科学， 2016， 硕士

【摘要】 目的:探讨进一步降低儿童DCD供肝肝移植术后肝动脉并发症的措施。方法:回顾性分析2011年7月至2014年4月我院完成的17例儿童DCD供肝肝移植临床资料。本组供肝符合DCD器官捐献标准,均由中国人体器官分配与共享系统(COTRS)分配。本组17例受者中胆道闭锁伴胆汁性肝硬化14例,原发性肝硬化失代偿1例,糖原累积症2例。术中14例供肝为全肝,1例供肝为左半肝,2例供肝为劈离肝,均无重要血管及胆道损伤。供体吻合动脉直径:0.2~0.5cm,受体吻合动脉直径:0.2~0.4cm。结果:术后6例发生肝动脉血栓(hepatic artery thrombosis,HAT),经介入或再次肝动脉吻合及微动脉插管持续尿激酶灌注后恢复供血,其中2例分别于术后21天及7天死于严重肺部肺炎克雷白杆菌感染,1例术后7天死于肝动脉血栓形成,1例术后5天死于严重毛细血管渗漏综合征,1例术后23天死于肠漏后感染性休克,1例术后1天死于因凝血功能严重障碍所致的失血性休克,其余11例顺利出院,健康生活至今。结论:儿童DCD供肝肝移植术后肝动脉血栓发生率较高,有效的选择肝动脉支进行吻合及良好的动脉吻合技术可以降低肝动脉血栓发生率,对肝动脉栓塞的可疑患者行剖腹探查、肝动脉介入造影检查及溶栓治疗可有效诊断和治疗肝动脉血栓。更多还原

【Abstract】 Objective: To investigate the measures to further reduce the hepatic artery complications after liver transplantation in children DCD.Methods: Retrospective analysis between July 2011 to April 2014 to complete the 17 children in our hospital DCD liver transplantation clinical data. The group meets DCD organ donation standards by Chinese human organ allocation and sharing system(COTRS). The group of 17 patients with Biliary atresia with biliary cirrhosis 14 cases, primary cirrhosis 1 case, glycogen storage disease 2 case. Graft surgery 14 cases for the whole liver, 1 case was left liver graft, 2 cases of liver graft is split off, there was no significant damage to the vascular and biliary. Donor artery anastomosis diameter :0.2~0.5cm, receptor anastomosis artery diameter :0.2~0.4cm.Results: 6 cases of postoperative hepatic artery thrombosis(HAT), 2 patients died of severe lung infection in Klebsiella pneumoniae after 21 days and 7 days,1 patients died of hepatic artery thrombosis after 7 days.1 patients died of severe capillary leak syndrome after 5 days, 1 patients died of hindgut drain septic shock after 23 days, 1 patients died of coagulation disorder caused severe hemorrhagic shock after 1 days, The remaining 11 cases successfully discharged, healthy living so far.Conclusion: DCD liver transplantation higher incidence of hepatic artery thrombosis in Children, arterial avoid choosing mutation or double artery bifurcation mouth anastomosis can reduce the incidence of hepatic artery thrombosis, laparotomy for suspected patients, hepatic artery interventional examination or hepatic arteriography effective diagnosis and treatment of hepatic artery thrombosis.更多还原