Abstract:

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 FirstCenter 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 colonfistula. 13 cases had 1-3 times of abdominal surgical operation history before liver transplantation. Results After1 to 3 months of combined therapy，16 cases were cured，1 patient died of respiratory failure from severerespiratory 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 livertransplantation is low，but the mortality rate ishigh. After the digestive tract fistula was diagnosed，early operation and infection control，strengthen nutrition，reasonable immunosuppressive usage and othercomprehensive treatments were the key methods to cure the patient.

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摘要：

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 1 543 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。

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