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第三节 肝移植的禁忌证和危险因素
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第三节 肝移植的禁忌证和危险因素

  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

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