CAJ | 학술논문

目的：探讨肝移植术后早期并发消化道瘘的临床诊断与治疗。方法2007年1月至2012年12月天津市第一中心医院完成1543例肝移植，其中18例早期并发胃肠道瘘，包括：胃瘘5例，十二指肠瘘5例，空肠瘘4例，回肠瘘1例，结肠瘘3例；其中13例患者肝移植术前曾有过1～3次腹部外科手术史。结果经过1～3个月的综合治疗，16例治愈出院，1例死于呼吸道严重感染所致的呼吸衰竭，1例死于严重腹腔感染致多器官功能衰竭。本组消化道瘘治愈率为88.9％，病死率为11.1％。随访6～24个月，未再发生消化道瘘。结论肝移植术后早期消化道瘘的发生率低，但病死率高。消化道瘘确诊后，早期手术、控制感染、加强营养、合理应用免疫抑制剂等综合治疗是治愈的关键。
목적：탐토간이식술후조기병발소화도루적림상진단여치료。방법2007년1월지2012년12월천진시제일중심의원완성1543례간이식，기중18례조기병발위장도루，포괄：위루5례，십이지장루5례，공장루4례，회장루1례，결장루3례；기중13례환자간이식술전증유과1～3차복부외과수술사。결과경과1～3개월적종합치료，16례치유출원，1례사우호흡도엄중감염소치적호흡쇠갈，1례사우엄중복강감염치다기관공능쇠갈。본조소화도루치유솔위88.9％，병사솔위11.1％。수방6～24개월，미재발생소화도루。결론간이식술후조기소화도루적발생솔저，단병사솔고。소화도루학진후，조기수술、공제감염、가강영양、합리응용면역억제제등종합치료시치유적관건。
Objective To investigate the clinical diagnosis and treatment of the early gastrointestinal fistula after liver transplantation. Methods 1 543 cases liver transplantation has been operated in Tianjin First Center Hospital from January,2007 to December,2012,of which 18 cases were complicated with gastrointestinal fistula. Those included 5 cases of gastric fistula,5 duodenal fistula,4 jejunal fistula,1 ileal fistula,and 3 colon fistula. 13 cases had 1-3 times of abdominal surgical operation history before liver transplantation. Results After 1 to 3 months of combined therapy,16 cases were cured,1 patient died of respiratory failure from severe respiratory tract infections,1 patient died of multiple organ failure resulted from severe abdominal infection. Recovery rate was 88.9%,and mortality rate was 11.1% in this gastrointestinal fistula group. There was no recurrence of gastrointestinal fistula during the 6-24 months follow up. Conclusions The incidence of early postoperative gastrointestinal fistula after liver transplantation is low, but the mortality rate is high. After the digestive tract fistula was diagnosed, early operation and infection control, strengthen nutrition,reasonable immunosuppressive usage and other comprehensive treatments were the key methods to cure the patient.