中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (08): 703-704.

• 论著 • 上一篇    下一篇

原位肝移植术后颅内出血原因和处理

马    毅，叶智明，孙灿辉，朱晓峰，何晓顺，王东平，王国栋，胡安斌，鞠卫强，巫林伟，邰    强   

  1. 中山大学附属第一医院器官移植中心，广东广州510080
  • 出版日期:2011-08-01 发布日期:2011-08-01

  • Online:2011-08-01 Published:2011-08-01

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摘要：

目的    探讨肝移植术后颅内出血的临床特点以及防治措施。 方法    回顾性分析中山大学附属第一医院2004年1月至2008年12月施行的638例肝移植病人的临床资料。总结原位肝移植术后颅内出血的诊治经过。结果    638例肝移植病人中共发生术后颅内出血10例（1.6%）；其中发生于移植术后1周内1例，2周内3例，2周至1个月6例。10例病人一经确诊，均立即采取脱水降低颅内压治疗，并应用抗生素控制感染，其中有4例病人急诊施行了开颅血肿清除术。10例中死亡6例，与术后颅内出血相关的病死率为60.0%。结论    肝移植术后颅内出血发病凶险、病死率高。应掌握术后颅内出血的常见原因，对术后意识和精神状态发生改变者要及时进行头颅CT检查，一旦发生颅内出血应积极抢救，及时做出正确的治疗选择，必要时施行开颅血肿清除术。

关键词: 肝移植, 手术后并发症, 颅内出血

Abstract:

Causes and treatment of intracranial hemorrhage after orthotopic liver transplantation        MA Yi, YE Zhi-ming, SUN Can-hui, et al. Department of Transplantation Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Corresponding author：MA Yi, E-mail：anhuimayi2002@163.com
Abstract    Objective    To investigate the clinical features and prophylactico-therapeutic measures of intracranial hemorrhage after orthotopic liver transplantation (OLT). Methods    The clinical data of 638 patients after OLT between January 2004 and December 2008 at the First Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively. The accumulated experiences in diagnosis and treatment of postoperative intracranial hemorrhage after OLT were reviewed. Results    Among the 638 patients, 10 patients (1.6%) suffered from intracranial hemorrhage. One patient happened within the first week after transplantation, 3 within 2 weeks, 6 within 4 weeks. Once the diagnosis is confirmed, dehydrative measures were taken immediately to decrease the intracranial pressure, and antibiotics were applied to control infection at the same time. Four patients underwent emergency craniotomy to clear the intracranial hematoma. Among 10 patients, 6 patients (60.0%) died. Conclusion    Intracranial hemorrhage after OLT is extremely dangerous with high mortality. Common causes of postoperative intracranial hemorrhage should be well known. Once the patients show any sign of abnormal consciousness, craniocerebral CT should be done immediately and appropriate treatments should be applied. Craniotomy should be performed to clear the hematoma when needed.

Key words: liver transplantation, postoperative complications, intracranial hemorrhage