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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
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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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