Khalaf H, Negmi H, Hassan G, Al-Sebayel M
Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Transplant Proc. 2004 Sep;36(7):2158-9. doi: 10.1016/j.transproceed.2004.08.126.
Postoperative alopecia areata (PAA) following surgery has been reported, especially after certain gynecologic and cardiac procedures; however, no cases have been reported after liver transplant (LT). Localized pressure associated with prolonged anesthesia is usually blamed. Herein we report a few cases of PAA encountered especially in relation to LT procedures.
To report our PAA cases, identifying possible contributing risk factors.
Between April 2001 and May 2003 the data on eight PAA cases were analyzed for age, sex, type of surgery, duration of anesthesia, type of head support, periods of hypotension, and psychiatric comorbidity.
Median age of affected patients was 27 years (10 to 44) and the male/female ratio 3/5. The type of surgery included: two LT recipients, two LT donors, three cardiac valve replacements, and one coronary bypass surgery. Median anesthesia time was 6 hours (3 to 12). Sponge or jelly donut was used for head support with frequent change of its position as per protocol. There were no significant periods of hypotension. Surprisingly, almost all patients had a documented psychiatric comorbidity, mainly anxiety, adjustment/adaptation, or mood disorders.
PAA is a rare complication following certain surgeries including both donor and recipient LT procedures. Although pressure-induced ischemia is the most likely etiological factor, we believe that psychiatric comorbidity plays a major role in its development. Therefore, preoperative thorough psychiatric counseling in addition to frequent intraoperative head repositioning will help to avoid this minor but distressing postoperative complication.
术后斑秃（PAA）已有报道，尤其是在某些妇科和心脏手术后；然而，肝移植（LT）后尚无相关病例报道。通常认为与长时间麻醉相关的局部压力是其原因。在此，我们报告几例特别是与肝移植手术相关的PAA病例。
报告我们的PAA病例，确定可能的促成风险因素。
分析2001年4月至2003年5月期间8例PAA病例的数据，包括年龄、性别、手术类型、麻醉持续时间、头部支撑类型、低血压期以及精神疾病合并症。
受影响患者的中位年龄为27岁（10至44岁），男女比例为3/5。手术类型包括：2例肝移植受者、2例肝移植供者、3例心脏瓣膜置换术和1例冠状动脉搭桥手术。中位麻醉时间为6小时（3至12小时）。使用海绵或果冻圈进行头部支撑，并按规程频繁更换其位置。无明显低血压期。令人惊讶的是，几乎所有患者都有精神疾病合并症记录，主要是焦虑、适应/调整或情绪障碍。
PAA是包括肝移植供者和受者手术在内的某些手术后罕见的并发症。虽然压力诱导的缺血是最可能的病因，但我们认为精神疾病合并症在其发生中起主要作用。因此，除了术中频繁重新定位头部外，术前进行全面的精神咨询将有助于避免这种轻微但令人苦恼的术后并发症。
