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护理学报 ›› 2021, Vol. 28 ›› Issue (18): 50-52.doi: 10.16460/j.issn1008-9969.2021.18.050

• 临床护理:外科护理 • 上一篇    下一篇

胆道闭锁患儿肝移植术后并发症的观察及护理

田文杰a,b, 吕毅a,b, 王凯玲b, 杨勤玲a, 肖奇贵a   

  1. 西安交通大学第一附属医院 a.肝胆外科; b.精准外科与再生医学国家地方联合工程研究中心,陕西 西安 710061
  • 收稿日期:2021-05-11 出版日期:2021-09-25 发布日期:2021-10-12
  • 通讯作者: 肖奇贵（1977-）,女,陕西西安人,硕士,主管护师。E-mail：learner969@sina.cn
  • 作者简介:田文杰（1989-）,女,陕西西安人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    国家自然科学基金项目（81727802; 81470896）

Nursing of Complications after Liver Transplantation in Children with Biliary Atresia

TIAN Wen-jiea,b, LV Yia,b, WANG Kai-lingb, YANG Qin-linga, XIAO Qi-guia   

  1. a. Dept. of Hepatobiliary Surgery; b. National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2021-05-11 Online:2021-09-25 Published:2021-10-12

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摘要： 目的 总结胆道闭锁患儿肝移植术后并发症的观察及护理要点,并推广护理经验。方法 对4例胆道闭锁患儿行肝脏原位植入术术后血管并发症、感染的预防及控制、消化道瘘及术后营养支持、胆道并发症等的观察和针对性护理措施进行分析,总结护理经验。结果 1例患儿术后出现感染症状,给予动态调整抗感染方案,落实保护性隔离措施,顺利出院。1例患儿术后出现了消化道瘘,经过手术及营养支持,严密观察治疗后消化道功能逐渐恢复,经过积极治疗护理,顺利康复出院。4例患者出院后随防至术后1年,无其他严重并发症。结论 胆道闭锁患儿肝移植术后在做好常规围手术期管理的基础上,重视患儿术后血管并发症、感染、消化道瘘等并发症的观察护理,同时根据患儿术中情况,个体差异等特例,预警可能出现并发症,改善肝移植患儿预后,促进患儿康复。

关键词: 胆道闭锁, 小儿肝移植, 并发症, 护理

Abstract: Objective To summarize the observation and nursing points of postoperative complications in children with biliary atresia after liver transplantation, and to popularize the nursing experience. Methods Four children with biliary atresia received liver transplantation. Postoperative complications including vascular complications, biliary complications, prevention and control of infection, and gastrointestinal fistula and biliary complications were observed. Targeted nursing measures such as postoperative nutritional support were provided, then the nursing experience was summarized. Results One child with infection after operation was given dynamic anti-infection program and protective isolation measures then discharged successfully. One child had gastrointestinal fistula after surgery. With operation treatment and nutritional support, the digestive tract function gradually recovered and the child discharged after close observation and treatment. one-year follow-up found no other serious complications in 4 patients after discharge. Conclusion Close observation and nursing of complications in children after liver transplantation can significantly improve the prognosis of children with liver transplantation, improve the survival rate, and the rehabilitation of liver transplantation in children.

Key words: biliary atresia, pediatric liver transplantation, complication, nursing

中图分类号: 

  • R473.6
[1] Wang J, Xu Y, Chen Z, et al.Article Liver Immune Profiling Reveals Pathogenesis and Therapeutics for Biliary Atresia[J]. Cell, 2020, 183(7):1867-1883.DOI:10.1016/j.cell.2020.10.048.
[2] Tessier ME, Harpavat S, Shepherd RW, et al.Beyond the Pediatric End-stage Liver Disease System: Solutions for Infants with Biliary Atresia Requiring Liver Transplant[J]. World J Gastroenterol,2014,20(32):11062-11068.DOI:10.3748/wjg.v20.i32.11062.
[3] Kelly D, Verkade HJ, Rajanayagam J, et al.Late Graft Hepatitis and Fibrosis in Pediatric Liver Allograft Recipients: Current Concepts and Future Developments[J]. Liver Transpl,2016,22(11):1593-1602.DOI:10.1002/lt.24616.
[4] Chen J, Weinstein J, Black S, et al.Surgical and Endovascular Treatment of Hepatic Arterial Complications Following Liver Transplant[J]. Clin Transplant, 2014, 28(12):1305-1312.DOI:10.1111/ctr.12431.
[5] Cavalcante ACBS, Zurstrassen CE, Carnevale FC, et al.Long-term Outcomes of Transmesenteric Portal Vein Recanalization for the Treatment of Chronic Portal Vein Thrombosis after Pediatric Liver Transplantation[J]. Am J Transplant, 2018,18(9):2220-2228.DOI:10.1111/ajt.15022.
[6] Ghabril M, Agarwal S, Lacerda M,et al.Portal Vein Thrombosis is a Risk Factor and Outcomes after Liver Transplantation:Analysis of Risk Factors and Outcomes for Portal Vein Thrombosis in Waitlisted Patients[J]. Transplantation,2016, 100(1):126-133.DOI:10.1097/TP.0000000000000785.
[7] 孙雁,于立新,刘懿禾,等. 耐碳青霉烯类肠杆菌科细菌在肝移植患儿中定植与感染的调查分析[J]. 中华小儿外科杂志,2020,41(10):881-888.DOI:10.3760/cma.j.cn421158-20190707-00423.
[8] Neto JS, Feier FH, Bierrenbach AL, et al.Impact of Kasai Portoenterostomy on Liver Transplantation Outcomes: A Retrospective Cohort Study of 347 Children with Biliary Atresia[J]. Liver Transpl, 2015, 21(7):922-927.DOI:10.1002/lt.24132.
[9] 郭跃华,党雁,章朋,刘姝.6例高位小肠坏死早产儿Bishop-Koop肠造口术后护理[J].护理学报,2021, 28(5):59-61.DOI:10.16460/j.issn1008-9969.2021.05.059.
[10] Pereira P, Peixoto A.Biliary Complications - The “Achilles Heel” of Orthotopic Liver Transplantation[J]. GE P rt J Gastroenterol, 2018, 25(1):1-3.DOI:10.1159/000480489.
[11] 陆晔峰. 儿童肝移植术后长期生存的相关问题分析[J]. 临床肝胆病杂志,2019, 35(11):2396-2401.DOI:10.3969/j.issn.1001-5256.2019.11.004.
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