背驮式肝移植同步脾切除严重并发症与对策

摘要

目的 探讨背驮式肝移植同步脾切除出现严重并发症的原因与防治对策.方法 回顾性分析该院近十年实施背驮式肝移植患者的临床资料,重点对患者的临床特征及处理经验进行分析.结果 (1)在手术临床探索期行背驮式肝移植同步脾切除28例,患者术后1个月重度和极重度感染的发生率分别为35.7％和10.7％;(2)3例极重度感染患者同时并发肝脓肿、脑脓肿和脾窝脓肿等严重并发症而死亡;(3)在手术临床探索期行背驮式肝移植同步脾切除患者术后1个月和1年的死亡率均高于对照组(17.9％比3.4％,P=0.022;35.7％比8.6％,P=O.002).结论 背驮式肝移植同步脾切除可增加患者术后感染率并导致严重并发症,增加患者死亡率.肝移植时应严格控制脾切除指征,延迟免疫抑制剂应用并采取相应处理措施.%Objective To explore the causes of serious complications and the countermeasures after splenectomy in piggyback liver transplantation (PBLT).Method A retrospective clinical study was conducted on all patients who received PBLT in our center in the past decade,focusing on our experience in concomitant splenectomy with PBLT.Results The rate of severe infection was 35.7％ 30days after concomitant splenectomy with PBLT.The rate of overwhelming postsplemctomy infection(OPSI) was 10.7％; 3 OPSI patients developed serious complications such as liver abscess,brain abscess and splenic fossa abscess.The 30-day and 1 year mortality rates in concomitant splenectomy with PBLT were higher than the non splenectomy patients (17.9％00 vs 3.4％,P=0.022; 35.7％ vs8.6％,P=0.002; respectively).Conclusion Concomitant splenectomy with PBLT led to serious complications and increased the incidences of postoperative infection and mortality.This procedure should only be carried out under special indications.The use of immunosuppression may have to be modified and appropriate counter measures may have to be applied to decrease postoperative infective complications.