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肝移植术后腹腔出血原因分析及防治体会(附82例报告)

熊亮 黎利娟 安玉玲 魏绪霞 易慧敏

熊亮, 黎利娟, 安玉玲, 等. 肝移植术后腹腔出血原因分析及防治体会(附82例报告)[J]. 器官移植, 2016, 7(6): 463-466. doi: 10.3969/j.issn.1674-7445.2016.06.010
引用本文: 熊亮, 黎利娟, 安玉玲, 等. 肝移植术后腹腔出血原因分析及防治体会(附82例报告)[J]. 器官移植, 2016, 7(6): 463-466. doi: 10.3969/j.issn.1674-7445.2016.06.010
Xiong Liang, Li Lijuan, An Yuling, et al. Analysis on cause, prevention and treatment of intra-abdominal hemorrhage after liver transplantation: a report of 82 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 463-466. doi: 10.3969/j.issn.1674-7445.2016.06.010
Citation: Xiong Liang, Li Lijuan, An Yuling, et al. Analysis on cause, prevention and treatment of intra-abdominal hemorrhage after liver transplantation: a report of 82 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 463-466. doi: 10.3969/j.issn.1674-7445.2016.06.010

肝移植术后腹腔出血原因分析及防治体会(附82例报告)

doi: 10.3969/j.issn.1674-7445.2016.06.010
基金项目: 

广东省科技计划项目 2014A020211010

详细信息
    通讯作者:

    易慧敏. E-mail:ylhmin@hotmail.com.

  • 中图分类号: R617,R619

Analysis on cause, prevention and treatment of intra-abdominal hemorrhage after liver transplantation: a report of 82 cases

More Information
  • 摘要:   目的   探讨肝移植术后腹腔出血的原因和防治措施。   方法   回顾性分析82例肝移植手术患者的临床资料,根据有否出现腹腔出血,分为腹腔出血组(12例)和对照组(70例)。比较两组患者术前各项指标,包括年龄、终末期肝病模型(MELD)评分、凝血酶原时间(PT)、凝血酶原时间国际标准化比值(PT-INR)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血小板(Plt);比较两组患者术中出血量、供肝冷缺血时间、无肝期时间、手术时间等参数;比较两组患者的病死率。   结果   82例患者中,12例发生腹腔出血(发生率为15%),均需二次手术止血。其中腹腔出血组死亡4例(病死率为33%),对照组70例患者中死亡8例(病死率为11%),两组病死率比较差异无统计学意义(P>0.05)。两组患者的年龄、MELD评分、PT、INR、FIB、APTT、PLT等指标比较,差异均无统计学意义(均为P>0.05)。与对照组比较,腹腔出血组的术中出血量多、手术时间长及供肝冷缺血时间长,差异均有统计学意义(均为P<0.05),而两组的无肝期比较差异无统计学意义(P>0.05)。   结论   肝移植术后腹腔出血与供肝冷缺血时间长、术中出血量多及手术时间长有关。应在术前充分纠正凝血功能,提高外科手术技术,以减少术后腹腔出血发生率。

     

  • 表  1  两组患者术前和术中指标的比较

    Table  1.   Comparison of preoperative and intraoperative indexes of patients between two groups

    指 标腹腔出血组(n=12)对照组(n=70)P
    术前指标
    年龄(岁,x±s)52±1047±110.12
    MELD[分,M(R)]11(2~31)10(0~46)0.75
    PT [s,M(R)]15.9(10.6~44.3)14.8(10.6~54.4)0.97
    INR [M(R)]1.31(0.89~3.55)1.23(0.88~6.39)0.95
    FIB[g/L,M(R)]1.48(0.80~4.56)1.81(0.29~6.60)0.57
    APTT(s,x±s)43.1±18.444.9±22.60.78
    Plt[×109/L,M(R)]113(19~185)84(16~368)0.66
    术中指标
    手术时间(h,x±s)8.8±1.77.6±2.20.038
    无肝期[min,M(R)]41(30~59)45(28~420)0.497
    冷缺血时间(h,x±s)7.58±2.425.20±1.690.007
    术中出血量[ml,M(R)]7 000(500~28 800)2 000(100~18 000)0.001
    注:M(R)为中位数(全距)
    下载: 导出CSV
  • [1] Cleland S, Corredor C, Ye JJ, et al. Massive haemorrhage in liver transplantation: consequences, prediction and management[J]. World J Transplant, 2016,6(2):291-305. doi: 10.5500/wjt.v6.i2.291
    [2] Kao ML, Lin PY, Heish CE, et al. Predictors of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation[J]. Int J Surg,2013,11(10):1073-1077. doi: 10.1016/j.ijsu.2013.10.004
    [3] Reichert B, Kaltenborn A, Becker T, et al. Massive blood transfusion after the first cut in liver transplantation predicts renal outcome and survival[J]. Langenbecks Arch Surg,2014,399(4):429-440. doi: 10.1007/s00423-014-1181-y
    [4] Freire MP, Soares OI, Bonazzi PR, et al. Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: an analysis of the epidemiology, risk factors, and outcomes[J]. Liver Transpl,2013,19(9):1011-1019. doi: 10.1002/lt.v19.9
    [5] Dunn LK, Thiele RH, Ma JZ, et al. Duration of red blood cell storage and outcomes following orthotopic liver transplantation[J]. Liver Transpl,2012,18(4):475-481. doi: 10.1002/lt.23379
    [6] Esmat Gamil M, Pirenne J, Van Malenstein H, et al. Risk factors for bleeding and clinical implications in patients undergoing liver transplantation[J]. Transplant Proc,2012,44(9):2857-2860. doi: 10.1016/j.transproceed.2012.09.085
    [7] Cywinski JB, Alster JM, Miller C, et al. Prediction of intraoperative transfusion requirements during orthotopic liver transplantation and the influence on postoperative patient survival[J]. Anesth Analg,2014,118(2):428-437. doi: 10.1213/ANE.0b013e3182a76f19
    [8] Cywinski JB, You J, Argalious M, et al. Transfusion of older red blood cells is associated with decreased graft survival after orthotopic liver transplantation[J]. Liver Transpl,2013,19(11):1181-1188. doi: 10.1002/lt.v19.11
    [9] Li C, Mi K, Wen TF, et al. Risk factors and outcomes of massive red blood cell transfusion following living donor liver transplantation[J]. J Dig Dis,2012,13(3):161-167. doi: 10.1111/cdd.2012.13.issue-3
    [10] Bang SR, Ahn HJ, Kim GS, et al. Predictors of high intraoperative blood loss derived by simple and objective method in adult living donor liver transplantation[J]. Transplant Proc,2010,42(10):4148-4150. doi: 10.1016/j.transproceed.2010.10.017
    [11] Tao YF, Teng F, Wang ZX, et al. Liver transplant recipients with portal vein thrombosis: a single center retrospective study[J]. Hepatobiliary Pancreat Dis Int,2009,8(1):34-39. http://cn.bing.com/academic/profile?id=1585810449&encoded=0&v=paper_preview&mkt=zh-cn
    [12] Pandey CK, Singh A, Kajal K, et al. Intraoperative blood loss in orthotopic liver transplantation: the predictive factors[J]. World J Gastrointest Surg,2015,7(6):86-93. doi: 10.4240/wjgs.v7.i6.86
    [13] Gurusamy KS, Pamecha V, Davidson BR. Piggy-back graft for liver transplantation[J]. Cochrane Database Syst Rev,2011(1):D8258. http://cn.bing.com/academic/profile?id=1677967067&encoded=0&v=paper_preview&mkt=zh-cn
    [14] Kong HY, Huang SQ, Zhu SM, et al. Role of anhepatic time in endothelial-related coagulation in liver transplantation[J]. Minerva Anestesiol,2013,79(4):391-397. http://cn.bing.com/academic/profile?id=2416377691&encoded=0&v=paper_preview&mkt=zh-cn
    [15] Massicotte L, Beaulieu D, Roy JD, et al. MELD score and blood product requirements during liver transplantation: no link[J]. Transplantation,2009,87(11):1689-1694. doi: 10.1097/TP.0b013e3181a5e5f1
    [16] 张胜,周杰,谭永法,等. 肝移植术后腹腔大出血的相关因素分析[J]. 广东医学,2012,33(6):770-772. http://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201206025.htm

    Zhang S, Zhou J, Tan YF, et al. Analysis of related factors of abdominal hemorrhage after liver transplantation[J]. Guangdong Med J,2012,33(6):770-772. http://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201206025.htm
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出版历程
  • 收稿日期:  2016-09-06
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2016-11-15

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