肝移植术后自发性肝破裂出血1例报告

马健; 何力宏; 王凌云; 翟亚楠; 李汛; 张磊

doi:10.3969/j.issn.1001-5256.2022.04.030

肝移植术后自发性肝破裂出血1例报告

DOI: 10.3969/j.issn.1001-5256.2022.04.030

马健^1a,
何力宏²,
王凌云²,
翟亚楠^1b,
李汛^1a, , ,,
张磊^1a, , ,

1a.
兰州大学第一医院普外科，兰州 730000
1b.
兰州大学第一医院影像科，兰州 730000
2.
兰州大学第一临床医学院，兰州 730000

基金项目:

兰州大学第一医院院内基金 (ldyyyn2019-105);

甘肃省高等学校创新基金 (2021B-013)

伦理学声明：本例报告已获得患者知情同意。

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：马健负责拟定写作思路, 资料分析，撰写论文; 何力宏、王凌云、翟亚楠负责资料采集, 修改论文; 张磊、李汛负责指导撰写文章, 修改论文并最后定稿。

详细信息

通信作者:
李汛，lxdr21@126.com

张磊，drzhanglei@lzu.edu.cn

计量
- 文章访问数: 521
- HTML全文浏览量: 215
- PDF下载量: 32
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-26
- 出版日期: 2022-04-20

A case of spontaneous hepatic rupture and hemorrhage after liver transplantation

Jian MA^1a,
Lihong HE²,
Lingyun WANG²,
Yanan ZHAI^1b,
Xun LI^{1a
, ,
,},
Lei ZHANG^{1a
, ,
,}

1a.
Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
1b.
Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China
2.
The First Clinical Medical College, Lanzhou University, Lanzhou 730000, China

Research funding:

Hospital Fund of the First Hospital of Lanzhou University (ldyyyn2019-105);

Innovation Foundation of the Higher Education Institutions of Gansu Province, China (2021B-013)

More Information

Corresponding author: LI Xun, lxdr21@126.com(ORCID: 0000-0002-1452-613X); ZHANG Lei, drzhanglei@lzu.cn(ORCID: 0000-0001-9320-304X)

摘要

- 肝移植 /
- 破裂, 自发性 /
- 手术后出血
- Liver Transplantation /
- Rupture, Spontaneous /
- Postoperative Hemorrhage

HTML全文

图 1 围手术期肝功能主要指标变化

Figure 1. Profile of the perioperative liver function

下载: 全尺寸图片幻灯片

图 2 围手术期INR变化

Figure 2. Profile of the perioperative lNR

下载: 全尺寸图片幻灯片

图 3 围手术期凝血指标变化

Figure 3. Profile of the perioperative coagulation function

下载: 全尺寸图片幻灯片

图 4 围手术期Hb、PLT指标变化

Figure 4. Profile of the perioperative Hb and PLT

下载: 全尺寸图片幻灯片

图 5 术后第10天急查B超及全腹CT结果

注：a，超声示腹腔积血; b，CT示肝尾状叶增大、出血; c，CT示小网膜囊积血; d，CT示积血自肝尾状叶延伸至小网膜囊。蓝色箭头示肝尾状叶区，红色箭头示积血。

Figure 5. Ultrasonography and abdominal CT scan on posttransplant 10th day

下载: 全尺寸图片幻灯片

图 6 剖腹探查所见

注：可见尾状叶破裂出血，行缝扎止血。蓝色箭头示肝尾状叶区，黄色箭头示肝动脉。

Figure 6. Intraoperative findings

下载: 全尺寸图片幻灯片

参考文献(17)

[1]	ADAM R, KARAM V, CAILLIEZ V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation[J]. Transpl Int, 2018, 31(12): 1293-1317. DOI: 10.1111/tri.13358.
[2]	KIM DS, LEE SG, SUNG GB, et al. Management of subcapsular hematoma of the graft after living donor liver transplantation[J]. Liver Transpl, 2006, 12(7): 1124-1128. DOI: 10.1002/lt.20791.
[3]	MOON DB, LEE SG, HWANG S, et al. Massive subcapsular hematoma of liver graft after living donor liver transplantation: A case report[J]. Transplant Proc, 2003, 35(4): 1469-1472. DOI: 10.1016/S0041-1345(03)00471-8.
[4]	DING ZY, CAI B, ZHAO Y. Experience in the diagnosis and intraoperative treatment of liver rupture after transplantation[J]. Chin J Modern Operative Surg, 2010, 14(6): 481. https://www.cnki.com.cn/Article/CJFDTOTAL-XDSS201006027.htm 丁忠阳, 蔡兵, 赵翼. 移植肝脏破裂的诊断和术中处理体会[J]. 中国现代手术学杂志, 2010, 14(6): 481. https://www.cnki.com.cn/Article/CJFDTOTAL-XDSS201006027.htm
[5]	SENZOLO M, BURRA P, CHOLONGITAS E, et al. New insights into the coagulopathy of liver disease and liver transplantation[J]. World J Gastroenterol, 2006, 12(48): 7725-7736. DOI: 10.3748/wjg.v12.i48.7725.
[6]	HSU SC, THORAT A, POON KS, et al. Management of liver allograft trauma resulting in massive subcapsular hematoma after living donor liver transplantation: Can we salvage the liver allograft?[J]. Ann Transplant, 2017, 22: 1-8. DOI: 10.12659/aot.901006.
[7]	BROCKMANN JG. Liver damage during organ donor procurement in donation after circulatory death compared with donation after brain death (Br J Surg 2013; 100: 381-386)[J]. Br J Surg, 2013, 100(3): 386-387. DOI: 10.1002/bjs.9010.
[8]	Chinese Society of Organ Transplantation, Chinese Medical Association. Technical specifications for obtaining donor liver for liver transplantation in China (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2700-2702. DOI: 10.3969/j.issn.1001-5256.2019.12.011. 中华医学会器官移植学分会. 中国肝移植供肝获取技术规范(2019版)[J]. 临床肝胆病杂志, 2019, 35(12): 2700-2702. DOI: 10.3969/j.issn.1001-5256.2019.12.011.
[9]	TANG R, WU GD, YANG W, et al. Management of graft laceration in orthotopic liver transplantation[J]. J Hepatopancreatobiliary Surg, 2021, 33(6): 321-324. DOI: 10.11952/j.issn.1007-1954.2021.06.001. 汤睿, 吴广东, 杨威, 等. 原位肝移植供肝撕裂伤的处理[J]. 肝胆胰外科杂志, 2021, 33(6): 321-324. DOI: 10.11952/j.issn.1007-1954.2021.06.001.
[10]	WANG ZH, GUO WZ. The diagnosis and treatment of vascular complications following liver transplantAtion[J]. Chin J Organ Transplant, 2019, 40(11): 641-642. DOI: 10.3760/cma.j.issn.0254-1785.2019.11.001. 王智慧, 郭文治. 肝移植术后血管并发症的诊断与治疗[J]. 中华器官移植杂志, 2019, 40(11): 641-642. DOI: 10.3760/cma.j.issn.0254-1785.2019.11.001.
[11]	NISSEN NN, GELLER SA, KLEIN A, et al. Percutaneous liver biopsy after living donor liver transplantation resulting in fulminant hepatic failure: The first reported case of hepatic compartment syndrome[J]. J Transplant, 2010, 2010: 273578. DOI: 10.1155/2010/273578.
[12]	LUPASCU C, APOPEI O, VLAD N, et al. Early spontaneous graft intra- and perihepatic hematoma after liver transplantation[J]. Chirurgia (Bucur), 2017, 112(3): 342-348. DOI: 10.21614/chirurgia.112.3.342.
[13]	Perioperative Management Group, Chinese Society of Organ Transplantation, Chinese Medical Association. Expert consensus on perioperative management of coagulation function in adult liver transplant recipients[J/CD]. Prac J Organ Transplant(Electronic Version), 2021, 9(2): 89-94. DOI: 10.3969/j.issn.2095-5332.2021.02.001. 中华医学会器官移植学分会围手术期管理学组. 成人肝移植受者围术期凝血功能管理专家共识(2021版)[J/CD]. 实用器官移植电子杂志, 2021, 9(2): 89-94. DOI: 10.3969/j.issn.2095-5332.2021.02.001.
[14]	WANG GG, LI Q, WANG S, et al. Dynamic changes of thromboelastography and coagulation function parameters before and after liver transplantation and its significance for guidance of blood transfusion[J]. J Prac Hepatol, 2020, 23(6): 901-904. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY202006038.htm 王广耕, 李茜, 王姗, 等. 肝移植患者凝血功能和血栓弹力图指标动态变化[J]. 实用肝脏病杂志, 2020, 23(6): 901-904. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY202006038.htm
[15]	Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)[J]. Ogran Transplantation, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002. 中华医学会器官移植学分会. 中国肝移植术后并发症诊疗规范(2019版)[J]. 器官移植, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002.
[16]	CHANG ZF, LI Q, LIU FY, et al. Endovascular treatment of liver rupture and bleeding[J/CD]. Chin J Interv Radiol(Electronic Edition), 2015, 3(2): 95-99. DOI: 10.3877/cma.j.issn.2095-5782.2015.02.011. 常中飞, 李强, 刘凤永, 等. 血管内介入治疗肝脏破裂出血[J/CD]. 中华介入放射学电子杂志, 2015, 3(2): 95-99. DOI: 10.3877/cma.j.issn.2095-5782.2015.02.011.
[17]	KOZAR RA, CRANDALL M, SHANMUGANATHAN K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney[J]. J Trauma Acute Care Surg, 2018, 85(6): 1119-1122. DOI: 10.1097/TA.0000000000002058.