原位肝移植术后侵袭性曲菌病的诊断和治疗  

Diagnosis and treatment of invasive aspergillosis infection following orthotopic liver transplantation

作　　者：易述红[1] 陈规划[1] 陆敏强[1] 杨扬[1] 蔡常洁[1] 许赤[1] 李华[1] 汪根树[1] 易慧敏[1] 

机构地区：[1]中山大学附属第三医院肝脏移植中心,广州510630

出　　处：《中华外科杂志》2006年第13期885-888,共4页Chinese Journal of Surgery

基　　金：国家重点基础研究发展计划(973课题)基金(2003CD515507);卫生部临床重点基金(2001321)资助项目

摘　　要：目的探讨原位肝移植术后侵袭性曲菌病的诊治。方法回顾性分析2000年1月至2005年1月完成的576例原位肝移植的临床资料,总结术后侵袭性曲菌病的防治经验。结果9例患者术后并发侵袭性曲菌病,疾病发生率为1．74％(9／576),首发感染部位为肺部8例,中枢神经系统感染1例,发病时间在术后10 d至2个月,术后持续或间断的低热可以是发病早期的主要症状。痰或其他分泌物的真菌镜检和培养是确诊的主要依据。二性霉素B脂质体是治疗的首选用药,对早期病例疗效满意,5例肺部感染患者痊愈,2例因肺部感染无法控制死亡,2例因并发多器官侵袭死亡。结论肝移植术后侵袭性曲菌病具有早期临床表现不典型和易于播散的特点,合理调整免疫抑制治疗方案及早期、足量和足程的抗真菌药物的使用是取得良好疗效的关键。Objective To explore the treatment and appropriate management of invasive aspergillosis infection following orthotopic liver transplantation. Methods The clinical data of 576 cases who underwent orthotopic liver transplantation consecutively between January 2000 and January 2005 were analyzed retrospectively, Results The prevalence of invasive aspergillosis infection was 1.74 （ 9/576 ）, included 8 cases with pulmonary aspergillosis and 1 case with cerebral aspergillosis, The interval between transplantation and diagnosis were from 10 days to 2 months. Persistent or discontinuous low fever maybe the main clinical presentation after operation. Liposomal amphotericin B （AmBisome） is the mainly treatment for invasive aspergillosis infections, 5 patients were cured and 2 patients developed multi-organ aspergillosis infection died. Conclusions The clinical features of invasive aspergillosis infection following orthotopic liver transplantation were un-typical presentations in the early stage and easy to disseminate. Appropriate modification of immunosuppression therapy and early, high dose and long-term application of antifungal treatment is effective and safe to cure the disease.

关 键 词：肝移植 手术后并发症 曲霉菌属 

分 类 号：R657.3[医药卫生—外科学] R736.4[医药卫生—临床医学]