原位肝移植术后并发曲霉菌感染的临床诊治分析  

Clinical analysis of aspergillosis in orthotopic liver transplant recipients

作　　者：刘振文[1] 邹卫龙[1] 朱晓丹[1] 张向兰[1] 刘煜[1] 沈中阳[1] 

机构地区：[1]武警总医院肝脏移植研究所,北京100039

出　　处：《中华肝脏病杂志》2005年第3期171-174,共4页Chinese Journal of Hepatology

摘　　要：目的 回顾性分析原位肝移植术后曲霉菌感染的临床特点及诊治经过,探讨改善预后措施。方法 回顾总结207例原位肝移植术患者的临床资料,分析术后曲霉菌感染的部位、影响因素、诊治经过及预后。 结果 207例原位肝移植患者中17例术后并发曲霉菌感染,发病率为8.21％。口腔黏膜感染5例,无死亡;深部曲霉菌感染12例,其中单一脏器曲霉菌感染8例:切口感染3例、无死亡,肺脏感染3例、2例死亡,肝脏感染2例、1例死亡;多脏器曲霉菌感染4例,全部死亡。死亡病例中重型肝炎5例,肝炎后肝硬化1例,原发性肝癌1例。 结论 长时间应用广谱抗菌素(≥3周)和免疫抑制剂是肝移植术后并发曲霉菌感染的主要原因;重型肝炎患者感染曲霉菌的风险更高。两性霉素B治疗深部曲霉菌感染有效;预防性应用抗真菌药物,常规监测、早期治疗将有助于改善曲霉菌感染的预后。Objective To assess the clinical features of aspergillosis and its diagnosis, prophylaxis and treatment in patients after orthotopic liver transplantation (OLT), and to improve the prognosis of the recipients. Methods Medical records of consecutive patients who underwent OLT in our liver transplant center from May 2002 to May 2004 were analyzed retrospectively. Those with aspergillus infection complications were studied in detail regarding their infected organs, related factors, treatments and prognoses. Results 17 out of 207 recipients of OLT were detected with aspergillosis. The incidence was 8.21 percent. 5 patients infected with superficial aspergillus survived. Of the 12 cases with deep aspergillus infection, 3 with infection limited to the sites of their incisions survived, 2 of the 3 patients with infection in their lungs, and 1 of the 2 patients with it in their livers died, and 4 recipients with multi-organ aspergillus infection died. Among the 7 cases that died, 5 had severe hepatitis, 1 had post-hepatitis liver cirrhosis and 1 had primary liver carcinoma. Conclusions Long-term (≥ 3 weeks) broad-spectrum antibiotics and immunosupression were involved in aspergillus infection in our OLT patients. Patients with chronic severe hepatitis had a higher risk of having aspergillus infection. Amphotericin B is still the best choice for treating aspergillosis. Prophylactic administration of anti-fungal medicine, surveillance of fungal infections as a routine, and treatment of the infection in time may help to improve the prognosis of OLT recipients with aspergillosis.

关 键 词：曲霉菌感染 术后 原位肝移植术 死亡 患者 预后 重型肝炎 结论 目的 常规 

分 类 号：R657.3[医药卫生—外科学]