第三节肝移植的禁忌证和危险因素
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《临床肝移植》
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
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
1 PT<15 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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