Xiong Jun, You Shen, He Xiao-Shun
Organ Transplantation Center, 1st Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
World J Gastroenterol. 2007 Apr 14;13(14):2125-8. doi: 10.3748/wjg.v13.i14.2125.
To describe cases of gut perforation after orthotopic liver transplantation.
Data were collected from our center database and medical records. Six of 187 patients (3.2%) who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation. All patients were male with an average age of 46 years. Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University.
Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min (range 45-72 min), median cold ischaemia time was 11.3 h (range 7-15 h). Median intraoperative blood loss was 500 mL (range 100-1200 mL) and median operation time was 8.8 h (range 6-12 h). None of the six patients developed acute cellular rejection. White cell count was above 18 x 10(9)/L in five patients (neutrophilic leukocytes were above 90%) and 1.5 x 10(9)/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation.
Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis, preferably through detection of enterococci may ensure better survival.
描述原位肝移植术后肠道穿孔的病例。
从我们中心的数据库和病历中收集数据。2005年1月至12月接受原位肝移植的187例患者中有6例（3.2%）发生肠道穿孔。所有患者均为男性，平均年龄46岁。原位肝移植在中山大学附属第一医院器官移植中心采用改良背驮式肝移植术进行。
发现既往手术、类固醇治疗、门静脉交叉阻断时间延长、营养状况差和医源性损伤是其相关因素。肠道穿孔患者出现发热、白细胞增多、轻度腹痛和压痛。门静脉阻断时间中位数为63分钟（范围45 - 72分钟），冷缺血时间中位数为11.3小时（范围7 - 15小时）。术中失血中位数为500毫升（范围100 - 1200毫升），手术时间中位数为8.8小时（范围6 - 12小时）。6例患者均未发生急性细胞排斥反应。5例患者白细胞计数高于18×10⁹/L（中性粒细胞高于90%），1例患者白细胞计数为1.5×10⁹/L。引流液细菌培养显示5例患者为肠球菌。在6例行原位肝移植的患者中，3例在改良背驮式肝移植术后存活，3例死亡。
成人原位肝移植术后会发生肠道穿孔。肝移植术中应仔细操作并尽量减少解剖，延长胃管留置时间，缩短门静脉阻断时间并减少类固醇剂量。如果未能预防肠道穿孔，那么早期诊断，最好通过检测肠球菌，可能确保更好的生存率。
