胎肝移植中并发播散性霉菌病治疗成功1例  

Disseminated mycosis in fetal liver transplantation——A cured case report

作　　者：彭矞云[1] 吕善根[1] 谭汉君[1] 姚善谦[2] 刘海川[2] 

机构地区：[1]中国人民解放军军医进修学院小儿内科 [2]中国人民解放军军医进修学院血液科

出　　处：《解放军医学院学报》1989年第3期202-205,共4页Academic Journal of Chinese PLA Medical School

摘　　要：并发于骨髓及胎肝移植中的全身播散性霉菌病是一种死亡率极高的严重并发症。本文介绍了本病的诊断及治疗并报道1例抢救成功的病例。在移植早期,骨髓造血及免疫功能尚未恢复时凡遇有G^-杆菌败血症样发热、皮疹、全身关节肌肉疼痛,眼症状:眼前烟雾、视物模糊、球结膜充血、眼底改变;肺,肝、肾等脏器病变即应考虑此病,及时、反复、多部位留送标本进行霉菌培养。采用强力、广谱抗菌素3日无效者不等培养结果回报即需采用静脉抗霉治疗,首选克霉灵+5-FC,待培养结果证实可改用二性霉素B+5-FC,大蒜素等及大力支持疗法是抢救成功的关键。The patient was a femal, 11 years old, with B cell ALL CR_1. After conditioning with CY (cyclophosphamide) 50 mg/kgx2, DNR (daunorubicin) 30 mg x1, she received FLT (fetal liver transplantation) which was 600 ml suspension of 6 unrelated donor's fetal liver. After FLT, on day 16, she developed fever, chills, skin rash, myodynia and arthrodynia, conjunctival congestion, megalohepatia, and jaundice, and SGPT levels raised up to 300 u/L (nv O-30u/L). Ultrasonogram B and CT revealed bilateral renal multiple abscesses. Blood, bone marrow, urine, sputum, stool cultures all revealed candida (nonalbicans). Sometimes, the sediments of unine contained black-gray masses, the examination of which showed large number of candida conolings and harpha. She was treated by a conbination of Amp B and 5-FC and Daktarin etc, and recovered. Follow-up for 1(1/2) year showed that the patient was still in CR and the complication of disseminated candida was cured eventually.

关 键 词：移植异体 移植 同种 移植物生存 白血病 真菌病 抗真菌剂 

分 类 号：R82[医药卫生—临床医学]