肝移植的禁忌证和危险因素
2012-04-01 01:28:56   来源：   作者：  评论：0 点击：

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
2ⅢⅣ期昏迷1可控制型
1间歇性意识不清0无
0无肝性脑病其他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1PT15 s
0无

　　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。
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