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目的探讨小儿肝移植术后管理经验以及近期并发症的防治。方法2001年11月至2003年12月行小儿肝移植7人8例次,其中亲体肝移植2例,减体积肝移植3例,劈离式肝移植2例。术后即送至ICU监护并监测重要脏器功能、凝血功能及生化指标,早期用免疫抑制剂和预防性应用抗生素,每日Doppler检查肝脏血流速度和频谱。结果1例术后第5d死于急性肾功能衰竭;其他近期并发症还包括:腹腔内大出血2例、门静脉栓塞1例、肝静脉狭窄1例、右上肺不张5例、成人呼吸窘迫综合征(ARDS)及肺炎2例、消化道出血3例、腹腔感染1例、伤口感染2例、病毒感染3例、肾功能损伤2例、胆道并发症2例、急性排斥反应2例。结论小儿可成功施行肝移植手术,然而,术后并发症的风险却不容忽视。
Objective To explore the management experience of pediatric liver transplantation and the prevention and treatment of recent complications. Methods From November 2001 to December 2003, 7 children underwent liver transplantation in 8 cases, including 2 cases of parental liver transplantation, 3 cases of reduced-size liver transplantation and 2 cases of split liver transplantation. Postoperative ICU monitoring and monitoring and monitoring of vital organs, coagulation and biochemical indicators, early use of immunosuppressive agents and prophylactic antibiotics, daily Doppler liver blood flow velocity and frequency spectrum. Results One patient died of acute renal failure 5 days after operation. Other recent complications included intra-abdominal hemorrhage in 2 cases, portal vein embolism in 1 case, hepatic vein stenosis in 1 case, right upper pulmonary atelectasis in 5 cases, adult respiratory distress syndrome (ARDS) and pneumonia in 2 cases, gastrointestinal bleeding in 3 cases, abdominal infection in 1 case, wound infection in 2 cases, viral infection in 3 cases, renal damage in 2 cases, biliary complications in 2 cases and acute rejection in 2 cases. Conclusion In children, liver transplantation can be successfully performed. However, the risk of postoperative complications can not be ignored.