Wang Y-G, Wu J-S, Jiang B, Wang J-H, Liu C-P, Peng C, Tian B-Z
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha 41005, China.
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, 253 Jiefangzhong Road, Changsha 41005, China.
West Indian Med J. 2015 Jun;64(3):218-22. doi: 10.7727/wimj.2014.055. Epub 2015 May 15.
This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extensive bleeding of surgical wound leading to massive haematocele and infection around the liver, and one case had postoperative lower oesophageal fistula leakage causing massive hydrops and infection under the left diaphragm. After definite diagnosis, 12 cases underwent surgery within three days, with no death. Among the four cases that underwent surgery three days after diagnosis, one case died of multiple-organ failure five days after abdominal cavity exploration, which was performed 21 days after liver transplantation. Severe abdominal infections after liver transplantation were the most common causes of death in perioperative liver transplantation. Comprehensive treatment with efficacious antibiotics, multiple-organ support, controlled surgical removal of the lesion, and adequate drainage establishment was the key to the entire treatment.
本研究旨在探讨原位肝移植术后严重腹腔感染的原因及治疗经验。对2004年3月至2011年11月期间186例原位肝移植围手术期严重腹腔感染患者的临床资料进行回顾性分析。186例患者中，16例发生严重腹腔感染：5例因胆管吻合口漏导致肝间隙大量积液及感染，10例因手术创面广泛渗血导致肝周大量血肿及感染，1例因术后食管下段瘘漏导致左膈下大量积液及感染。明确诊断后，12例在3天内接受手术，无死亡病例。在诊断后3天接受手术的4例患者中，1例在肝移植21天后进行腹腔探查，术后5天死于多器官功能衰竭。肝移植术后严重腹腔感染是肝移植围手术期最常见的死亡原因。有效抗生素、多器官支持、控制性手术切除病灶及充分建立引流的综合治疗是整个治疗的关键。
