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目的探讨婴幼儿肝移植术后非感染性并发症的防治经验。方法研究对象为13例同期行肝移植术婴幼儿,回顾性分析其手术情况、围术期处理、并发症发生情况及随访结局。结果手术均顺利,术中及术后均应用免疫抑制剂治疗,术后预防性给予抗感染、抗凝等治疗,同时监测患儿重要脏器功能、凝血功能、生化指标和免疫抑制剂血药浓度等;发生非感染性并发症肠瘘1例、胆漏2例、胆道吻合口狭窄1例、急性排斥反应2例、FK506相关性精神症状3例、肾功能损害2例、乳糜漏2例,经针对性治疗后11例存活,2例死亡。结论婴幼儿肝移植手术效果较好,但术后非感染性并发症发生率高且复杂多变,临床应根据其生理、病理特征和移植手术特点进行防治。
Objective To explore the prevention and treatment of noninfectious complications after liver transplantation in infants and young children. METHODS: Thirteen patients underwent liver transplantation at the same period. The surgical conditions, perioperative management, complications and follow-up were retrospectively analyzed. Results The operation was successful. All patients were treated with immunosuppressant intraoperatively and postoperatively. Antiproliferative and anticoagulant therapy were given prophylactically. The vital organs, blood coagulation, biochemical indexes and immunosuppressive agents were also monitored 1 case of non-infectious complication intestinal fistula, 2 cases of bile leakage, 1 case of biliary anastomotic stenosis, 2 cases of acute rejection, 3 cases of FK506-associated psychiatric symptoms, 2 cases of renal dysfunction, 2 cases of chyle leakage , 11 cases survived after targeted therapy and 2 died. Conclusion The effect of liver transplantation in infants and young children is better, but the incidence of postoperative noninfectious complications is high and complicated. The clinical treatment should be based on its physiological and pathological features and the characteristics of transplant surgery.