Shan Yuhua,Gu Song,Xu Min,et al.Differentiation and prognosis of intestinal obstruction after pediatric liver transplantation[J].Journal of Clinical Pediatric Surgery,2021,20(06):576-581,587.[doi:10.12260/lcxewkzz.2021.06.013]
小儿肝移植术后肠梗阻病因鉴别及预后分析
- Title:
- Differentiation and prognosis of intestinal obstruction after pediatric liver transplantation
- Keywords:
- Liver Transplantation/MT; Postoperative Complications; Intestinal Obstruction; Posttransplant Lymphoproliferative Disorder; Intestinal Perforation
- 分类号:
- R617;R725.742;R656.622
- 摘要:
- 目的 分析儿童肝移植术后肠梗阻的原因及预后，探讨肠梗阻病因的提示性因素。方法 对上海交通大学医学院附属上海儿童医学中心2013—2018年接诊的30例儿童肝移植术后肠梗阻患者的临床资料进行回顾性分析。结果 肝移植术后肠梗阻病因包括：移植后淋巴增生异常（posttransplant lymphoproliferative disorder，PTLD）8例，医源性胃肠道穿孔5例，粘连性肠梗阻10例，膈疝2例，自发性腹膜炎5例。30例中15例接受剖腹探查手术。总体生存率73.33%，死亡8例，其中PTLD 4例，医源性胃肠道穿孔3例，自发性腹膜炎1例；距离肝移植术平均时长PTLD为（13.4±10.5）个月，粘连性肠梗阻为（3.14±3.18）个月，自发性腹膜炎为（6.00±6.16）d；医源性胃肠道穿孔为（8.00±4.18）d。通过发病病因时间来预测术后3个月以内和3个月以后发生的肠梗阻：受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under curve，AUC）为1.000（P<0.0001）；通过发病时间预测PTLD和粘连性肠梗阻的AUC为0.856（P=0.011）。结论 PTLD和胃肠道穿孔是肝移植术后肠梗阻最常见原因，也是重要的致死原因，不同的发生时间对于病因有一定提示作用。
- Abstract:
- Objective To explore the cause and prognosis of intestinal obstruction after liver transplantation (LT) in children and explore the suggestive factors of etiology.Methods A retrospective analysis was performed for 30 children hospitalized with intestinal obstruction after LT from 2013 to 2018.Results The etiologies included posttransplant lymphoproliferative disorder (PTLD,n=8),gastrointestinal perforation due to surgical trauma (n=5),adhesive intestinal obstruction (n=10),diaphragmatic hernia (n=2) and spontaneous peritonitis (n=5).Fifteen children underwent exploratory laparotomy.The overall survival rate was 73.33%.The causes of death were PTLD (n=4),severe infection after perforation (n=3) and spontaneous peritonitis caused by systematic infection (n=1).The average occurring time was (13.4±10.5) months after LT for PTLD,(3.14±3.18) months for adhesive intestinal obstruction,(6.00±6.16) days for spontaneous peritonitis and (8.00±4.18) days for perforation.The cause of posttransplant intestinal obstruction occurring within 3 months or not could be predicted by receiver operating characteristic (ROC) curve of onset time and the area under curve (AUC) was 1.000 (P<0.0001);PTLD and adhesive intestinal obstruction could be differentiated by onset time and AUC was 0.856 (P=0.011).Conclusion PTLD and perforation are important causes of death.And different occurring times may hint at the cause.
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备注/Memo
收稿日期:2020-02-16;。
基金项目:上海市抗癌协会雏鹰计划（编号：SACA—CY20C11）
通讯作者:严志龙,Email:dryanzhilong@163.com