本文選題：肝移植 + 嬰幼兒��； 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:探討進(jìn)一步降低兒童DCD供肝肝移植術(shù)后肝動脈并發(fā)癥的措施。方法:回顧性分析2011年7月至2014年4月我院完成的17例兒童DCD供肝肝移植臨床資料。本組供肝符合DCD器官捐獻(xiàn)標(biāo)準(zhǔn),均由中國人體器官分配與共享系統(tǒng)(COTRS)分配。本組17例受者中膽道閉鎖伴膽汁性肝硬化14例,原發(fā)性肝硬化失代償1例,糖原累積癥2例。術(shù)中14例供肝為全肝,1例供肝為左半肝,2例供肝為劈離肝,均無重要血管及膽道損傷。供體吻合動脈直徑:0.2~0.5cm,受體吻合動脈直徑:0.2~0.4cm。結(jié)果:術(shù)后6例發(fā)生肝動脈血栓(hepatic artery thrombosis,HAT),經(jīng)介入或再次肝動脈吻合及微動脈插管持續(xù)尿激酶灌注后恢復(fù)供血,其中2例分別于術(shù)后21天及7天死于嚴(yán)重肺部肺炎克雷白桿菌感染,1例術(shù)后7天死于肝動脈血栓形成,1例術(shù)后5天死于嚴(yán)重毛細(xì)血管滲漏綜合征,1例術(shù)后23天死于腸漏后感染性休克,1例術(shù)后1天死于因凝血功能嚴(yán)重障礙所致的失血性休克,其余11例順利出院,健康生活至今。結(jié)論:兒童DCD供肝肝移植術(shù)后肝動脈血栓發(fā)生率較高,有效的選擇肝動脈支進(jìn)行吻合及良好的動脈吻合技術(shù)可以降低肝動脈血栓發(fā)生率,對肝動脈栓塞的可疑患者行剖腹探查、肝動脈介入造影檢查及溶栓治療可有效診斷和治療肝動脈血栓。
[Abstract]:Objective: to study the measures to reduce the complications of hepatic artery after DCD donor liver transplantation in children. Methods: the clinical data of 17 children with DCD donor liver transplantation from July 2011 to April 2014 were analyzed retrospectively. The donor liver met the standard of DCD organ donation and was distributed by Chinese Human Organ Distribution and sharing system (COTRS). There were 14 cases of biliary atresia with biliary cirrhosis, 1 case of primary cirrhosis decompensation and 2 cases of glycogen accumulation. During the operation, 14 cases of donor liver were whole liver and 1 case of donor liver was left half liver. 2 cases of donor liver were split liver without important vessel and bile duct injury. The diameter of donor anastomosis artery was 0.5 cm, and that of recipient anastomosis artery was 0.2 ~ 0.2cm. Results: (hepatic artery thromboembolism was found in 6 patients after operation. After interventional or re-anastomosis of hepatic artery and continuous infusion of urokinase by arteriole, blood supply was restored. Two of them died of severe Klebsiella pneumoniae infection on 21 and 7 days, respectively. One died of hepatic artery thrombosis 7 days after operation, one died of severe capillary leakage syndrome on 5 days after operation, and one died 23 days after operation. One case of septic shock after intestinal leakage died of hemorrhagic shock caused by severe coagulation dysfunction 1 day after operation. The other 11 cases were discharged from hospital smoothly and have been living healthily so far. Conclusion: the incidence of hepatic artery thrombosis in children with DCD donor liver transplantation is high. The effective choice of hepatic artery anastomosis and good arterial anastomosis technique can reduce the incidence of hepatic artery thrombosis, and explore the suspected patients with hepatic artery embolism by laparotomy. Hepatic arteriography and thrombolytic therapy can effectively diagnose and treat hepatic artery thrombosis.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R726.5

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