摘要
目的观察肝移植后受体感染发生的机会、类型和相关因素，同时介绍作者处理这些感染的经验。方法对香港大学玛丽医院从１９９１年１０月到１９９８年８月７８例肝移植病人，发生肝移植后受体感染的所有病例进行回顾性分析。结果７８例病人做了８０次肝移植。４３例（５４％）病人共发生７９次感染，平均每例发生１８次。７９次感染中，有５６次为细菌感染，１３次为病毒感染，７次为真菌感染，３次为结核杆菌感染。７８％的感染发生于移植后１个月内。２例病人在移植后１年内死于严重感染。１例病人在移植后１３个月死于同ＥＢ病毒感染相关的恶性淋巴瘤。同感染直接相关的死亡率为４％。肝移植后细菌性感染同术中输血量及手术技术失误（术后胆漏、胆道狭窄、肠穿孔、腹腔内大出血）有明显相关性（Ｐ＜００５）。３０例肝移植采用ＦＫ５０６代替环孢霉素的免疫抑制治疗方案，发现本组病例未发生ＣＭＶ感染，用环孢霉素的５０例肝移植中６例发生巨细胞病毒（ＣＭＶ）感染，两组之间差异有显著性意义（Ｐ＜０．０５）。结论感染是肝移植后主要的并发症。细菌性感染同术中输血量及手术技术失误有明显相关性。ＦＫＳ５０６代替环孢霉素的免疫抑制治疗方案的应用能减少ＣＭＶ感染。
Objective To report the incidence, types and risk factors of infections in liver transplant recipients and to present our experience in the management of these infections. Methods A retrospective study ofall patients who presented with infections after liver transplantation from October 1991 to August 1998 in QueenMary Hospital, Hong Kong,was carried out. Results Eighty liver transplantation operations were performed in 78patients Infeetions developed in 43(54% ) cases with a total of 79 episodes (a mean of 1. 8 episodes in eachcase. Among the 79 infections, 56 were bacterial, 13 were viral, 7 were fungal and 3 were mycobacterial. Seventy-eight percent (61/79 ) of the infections occurred in the first month after liver transplantation. Two patientsdied of severe infection within the first year after transplantation. One patient died of malignant lymphoma related toEpstein-Barr virus (EBV) infection thirteen months after liver transplantation. The mortality rate related to infectionwas 4 %. Missive intraoperative blood transfusion and surgical technical errors were correlated with bacterial infection (P<0. 05). No patient (0/30) in the FK506-treated group 'developed cytomegalovirus (CMV) infection,compared with 12 % (6/50 ) of the patlents who were treated with cyclosporine (P < 0. 05). Conclusions Infection is a major complication after liver transplantation, generally occurring in the first month. Increased intraoperative blood transfusion requirement and surgical technical errors may be responsible for bacterial infection. There isa lower incidence of CMV infection in the patients who received FK506 treatment.
出处
《中华肝胆外科杂志》
CAS
CSCD
1999年第3期163-167,共5页
Chinese Journal of Hepatobiliary Surgery
