微 信 题 库 搜 索
理论教学
内科学
风湿病学 神经病学 免疫与健康
儿科学 老年医学 更多
外科学
皮肤性病学 普通外科学 烧伤外科学
神经外科学 外科学总论 更多
其它科目
基础学科 临床专科 内科疾病
内科诊疗 外科诊疗 专科诊疗
外科疾病 专科疾病 临床专科疾病
 医学全在线 > 理论教学 > 外科学 > 临床肝移植 > 正文
肝移植的禁忌证和危险因素
来源:医学全在线 更新:2008/10/15 字体:

  一、禁忌证

  如果病人合并有下列疾病,应视为手术禁忌证。

  (1)血清中人类免疫缺陷病毒(HIV)阳性。

  (2)肝外恶性肿瘤。

  (3)胆管癌

  (4)严重的心肺疾病。

  (5)未控制的全身性感染。

  (6)其他脏器功能衰竭。

  (7)心理学方面的不适应。

  二、危险因素

  肝移植的主要危险因素包括:年龄偏大、肌营养不良昏迷腹水、活动性出血和既往有腹部手术史等。表3-1为Pittsburgh的术前评估表,可用来粗略预测肝移植术后病人的存活率。

表3-1 肝移植受体术前评估表

  分数 表现   分数 表现
昏迷 6 术中为昏迷状态 腹水 2 难控制型
2 ⅢⅣ期昏迷 1 可控制型
1 间歇性意识不清 0
0 肝性脑病 其他 2 胆红素300µmol/L
肌营养不良 2 重度肌营养不良 1 曲张静脉出血
1 轻度肌营养不良 1 胆管系统感染
0 无肌营养不良 1 自发性腹膜炎
既往手术史 2 多次胆管再建手术 2 年龄大于40岁
2 门腔静脉分流术 1 胆红素100µmol/L
1 每次开腹术 1 PT15 s
0    

  本表应用比分累计法,0-3分表示低危病人,如果等于或高于7分,意味着存在着比3分病人高1倍的危险性。单一的因素如术后出血等,与术后病人的存活率也明显相关。既往腹有手术史,特别是胆管手术史,将明显增加手术的难度。

  参考文献

  1.Feray C,Zignergo AL,Samuel D et al.Persistent hepatitis Bvirus infetion of mononuclear blood cells without concomitant infection.The liver transplantation model.Transplantation,1990,49:1155

  2.Pemetris AJ ,Todo S, Van Thiel Dhet al.Evolution of hepatitis B virus liver disease after hepatic replacement.Practical and theoretical consideration.Am J Pathol,1990,137:667

  3.O’Grady JG,Willians R.Liver transplantation for viral hepatitis .Br Med Bull.1990,46:481

  4.Mazzaferro V,Regalia E,Montalto F et al.Risk of HBV reinfection afeter liver transplantation in HbsAg-positive cirrhosis.Primary hepatocellular carcinoma is not a predictor for HBV recurrence.Liver ,1996,16:117

  5.Marsman WA,Wiesher RH,Batts KP et al.Fulminant hepatitis Bvirus:recurrence after liver transplantation in two patients also infected with hepatitis delta virus.Hepatology,1997,25:434

  6.Hart J.Busuttil RW,Lewm KJ.Disease recurrence following liver transplantation.Am J Surg Pathol.1990,14(Suppl1):79

  7.Martin P,Munoz SJ,DiBisceglia AM et al.Recurrence of hepatitis Cvirus infection after orthotopic liver transplantation.Hepatology,1991,13:719

  8.Gane EJ,Portinann BC,Waoumov NV et al .Long-term outcome of hepatitis Cinfection after liver transplantation.N Engl Med,1996,334:815

  9.Baber KH,Dalley G,Bahr MJ et al.Long-term outcome of hepatitis C virus infection after liver transplatation .Hepatology,1997,25 :202

  10.Terrault NA,Zhou S,Combs Cet al.Prophylaxis in liver transplant recipient using a fixed dosing schedule of hepatitis Bimmunoglobulin.Hepatology,1996,24:1327

  11.Van Thiel DH,Bonet H,Gavaler J et al ,Effect of alcohol use on allograft liver transplantation for alcoholic liver disease.Alcohol Chin Exp Res,1995,19:1151

  12.Maddrey WC.Bone disease in patients with primary biliary cirrhosis.Prog Liver Dis,1990,9:537

  13.Shapiro JM,Smith H,Schaffner F.Serum bilirubin: a prognostic factor in primary biliary cirrhosis.Gut,1979,20:137

  14.Mentna G,Giostra E,Rubbia L et al .Follow-up and result of liver transplantation of primary biliary cirrhosis.Swiss Surg,1996,3:116

  15.Knoop M,Bechstein Wo,Schrem H et al.Chinical significance of recurrent primary billiary cirrhosis after liver transplantation .Transpl Int,1996,9(Suppl 1):S115

  16.Sternlieb I.Wilson’s disease:indication for liver transplantation.Hepatology,1984,4:155

  17.Exquive CO,Marino IR,Fioravanti V et al.Liver transplantation formetabolic disease of the liver,Gastroenterol Clin N Am,1988,17:167

  18. Ismail T,Angrisani L,Gunson BK et al,Primary hepatic malignancy:The role of liver transplantation,Br J Surg,1990,77:983

  19.Hoofnagle JH,Carithevs RC Jr,Shapiro Cet al.Fulminant hepatic failure:summary of a workshop.Hepatology,1995,21:240

  20.Williams R,Wendon J.Indication for orthotopic liver transplantation in fulminant liver failure.Hepatology,1994,20:1.

  21.Ludwing J,LaRusso NF,Wiesner RH.The syndrome of primary sclerosing cholangitis.Prog Liver Dis,1990,9:555

  22 .Rosen CB,Nagorney DM,Wiesner RH et al.Cholangiocarcinoma complicating primary sclerosing cholangitis .Ann Surg,1991,213:21

  23.Olsson R,Panielsson ,A,Jarnerot G et al .Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.Gastroenterology,1991,11:1319

  24.Higashi H,Yanaga K,Marsh JW et al.Development of colon cancer after transplantation for primary sclerosing cholangitis associated with ulcerative colitis.Hepatology,1990,11:477

  25.Alayoglu M,Stratta RJ,Sollinger HW .Liner transplantation in infans and children.J Pediatr Surg,1989,24:70

  26.Salerno F,Borroni G,Moser Pet al .Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for liver transplantation A prospective multicenter Italian study.AISF Group for the Study of Liver Transplantation.Association Italiana per lo Studio del Fegato.Hepatol.1996,25474

相关文章
187-3 恐怖障碍
197-3 心脏病人体格检查
266-3 成视网膜细胞瘤
3-6 纵隔病变X线表现
219-3 阴茎异常勃起
   触屏版       电脑版       全站搜索       网站导航   
版权所有:医学全在线(m.med126.com)
   触屏版       电脑版       搜索   
版权所有:医学全在线(m.med126.com)
网站首页
频道导航
医学论坛
返回顶部
Baidu
map