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Objective To explore the prophylaxis and treatment strategies for psychic syndrome in patients after piggyback liver transplantation.Methods The data on the etiology,treatment outcome and prognosis of psychic syndrome occurring in 45 of 235 patients who had piggyback liver transplantation were retrospectively analyzed.Results The incidence of psychic syndrome complication was 19.1%(45/235),22 cases presented as mania(48.9%),5 cases as tristimania(11.1%),3 cases as hallucinosis(6.7%),1 case as suicidal tendency(2.2%),1 case as metamorphopsia(2.2%),8 cases as angst insomnia(17.8%),2 cases as maladjusted disturbance(4.4%),3 cases as affective disturbance(6.7%),and the majority presented as delirious alienation.All the cases were cured,except 1 case of coma,who was confirmed by CT to have intracranial hemorrage,died after failure of resuscitation.Conclusions The incidence of psychic syndrome in patients after piggyback liver transplantation is relatively high.However,most cases have mild symptoms and the prognosis is fine.When the patients have psychogenic symptoms,the prognosis of patients can be improved by some symptomatic treatment strategies directed to their different clinical manifestations.
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ObjectiveTo investigate the methods of hepatic arterial reconstruction in orthotopic liver (transplantation)(OLT), and the prevention and management of associated complications, so as to improve the therapeatic results and donor survival rate of OLT.MethodsThe clinical data of 85 cases of orthotopic liver transplantation performed in our institute from May 1995 to May 2004 were retrospectively analysed. Hepatic artery reconstruction was made by use of Carrels patch of donor celiac artery or bifurcation of donor common hepatic artery and splenic artery anastoniosed to left and right hepatic artery of recipient in 16 cases((18.82)%), to bifurcation of gastroduodenal and proper hepatic arteries of recipient in 61 cases((71.76)%), or use of donor iliac artery interposition graft to abdominal aorta in 8 cases(9.42%). Regular heparin or low-molecular-weight heparin as a prophylactic anticoagulation therapy was maintained during and after (operation) as indicated by prothrombin time. Intra-and postoperative Doppler ultrasonography was used to (monitor) hepatic arterial blood supply.ResultsHepatic artery thrombosis(HAT) was observed in 1 case (intraoperatively)(overall incidence 1.2%).Thrombectomy and reconstruction of the arterial anastomosis were performed immediately.This patient currently has a survival time of 13 months without HAT. HAT was not observed in any of the other 84 cases during the follow up of 2 to 52 months.Conclusions Hepatic artery thrombosis may be minimized by proper selection of anastomotic site of hepatic artery reconstruction and (effective) use of postoperative anticoagulation.Close follow-up by Doppler ultrasonography may make a prompt diagnosis of HAT, salvage grafts and avoid re-transplantation.
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Objective To investigate the causes and treatment of encephalopathy occurred after orthotopic liver transplantation(OLT). Methods The clinical data of consecutive 51 patients who undergoing OLT were analyzed retrospectively. Results Encephalopathy occurred in 6 cases within one month after operation.The incidence of encephalopathy after OLT was 11.8%(6/51). All the 6 cases were cured by application of sedative agent and dopamine recipient blocking agent(aloperidin). Conclusions The etiology of encephalopathy following OLT is thought to be multifactors including metabolism desturbance before and after OLT,blood dynamics alternation during opration,application of immuosuppression drug etc. Application of sedative agent and dopamine recipient blocking agent may result in ideal effects in treating the encephalopathy.
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Objective To observe the changes in hypersplenism after orthotopic liver transplantation(OLT) and investigate the effect of OLT on hypersplenism. Methods Based on the clinical data of 14 eligible OLT patients operated on in our hospital during two and a half years, an analysis of the pre operative values of the thickness of the spleen, blood WBC and PLT count was made,and the postoperative pattern of changes of portal flow velocity was observed. Results Blood WBC and PLT count returned to normal 1 month after the operation, and the thickness of spleen reduced about 17.0% in the first month , but had no additional change at 1 year later. Portal flow velocity increased significantly 1 month after operation , then decreased slowly in the first year. Portal flow velocity , blood WBC and PLT count were all significantly related to the thickness of the spleen. Conclusions The high velocity of portal flow after OLT was mostly attributed to increased flow from the splenic vein; the main cause of the decrease in the level of blood WBC and PLT in hypersplenism before operation is augmentation of splenic volume; the recuperation of hypersplenism after OLT relies on the extent of reversion of splenic volume. It is not necessary to perform splenectomy in patients with hypersplenism when they receive OLT.
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Objective To explore the diagnosis and management of arterial complications after orthotopic liver transplantation (OLT). Methods The incidence, diagnosis and management of arterial complications of 180 OLT patients were analyzed retrospectively. Results A 5.0%(9/180)arterial complication rate was identified by selective angiography (8/9) and autopsy (1/9) in the 180 recipients, including 5 cases of hepatic artery thrombosis (HAT),3 cases of hepatic artery stenosis (HAS)and 1 celiac artery stenosis. Diagnostic sensitivity and specificity for arterial complications by color Doppler image (CDI) were 88.9% and 95.9% .The diagnostic sensitivity, specificity, positive and negative predictive value of intraoperative ultrasonography (IOUS) for arterial complications were 100%, 96.0%, 66.7% and 100%, respectively . Interventional procedures, revascularization, retransplantation and conservative treatment were used for 3,3,2 and 1 recipient respectively. Three patients were cured and 6 patients died. Conclusions CDI is a sensitive and specific way of monitoring arterial complications after OLT, and IOUS contributes to the early diagnosis. Revascularization and retransplantation are principal management for the patients with HAS or HAT. The conservative treatment might be effective for some asymptomatic patients, but interventional procedures may not obtain good results.