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田青山; 冯少培; 郭亚民; 韩秀敏; 赵顺云; 叶成杰; 安永德; 吴世乐; 王向前; 郑海波; 朱文君; 阿吉德; 高伟; 潘洪帅
临床肝胆病杂志, 09/2021, Volume: 37, Issue: 9Journal Article
R532.32%R617; 目的 探讨高原地区体外肝切除联合自体肝移植术治疗终末期肝泡型包虫病的术后并发症并探讨防治策略.方法 收集青海省人民医院2013年1月—2019年3月接受自体肝移植术的11例终末期肝泡型包虫病患者的手术资料及随访资料,对术中及术后情况进行分析.结果 11例患者均成功行自体肝移植术,无术中死亡,其中2例(18.18%)行半离体肝切除,9例(81.82%)行全离体肝切除.肝后下腔静脉重建方式中,采用自体大隐静脉进行重建者2例(18.18%),采用人造血管重建者4例(36.36%),5例(45.45%)保留自体肝后下腔静脉.胆道重建方式中,8例(72.73%)行胆肠吻合术,3例(27.27%)行胆管端端吻合术.11例患者的术后并发症主要有出血2例(18.18%);胆汁漏、腹腔感染4例(36.36%),胆肠吻合口狭窄1例(9.09%),血栓2例(18.18%),肺部感染、胸腔积液2例(18.18%);包虫复发1例(9.09%).11例患者发生围术期死亡2例(18.18%),其余9例(81.82%)患者均好转出院.结论 出血、胆道并发症和感染是造成高原地区自体肝移植患者死亡的主要原因,精准把握手术适应证、术前仔细多学科评估、术中精湛的操作、外科技术流程的标准化及精细的围术期管理是降低自体肝移植术围术期病死率、避免和减少术后并发症以及使患者获得长期良好生存的关键.
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