中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (44): 8189-8192.doi: 10.3969/j.issn.1673-8225.2011.44.006

• 肝移植 liver transplantation • 上一篇    下一篇

肝移植后肺外细菌感染：同一机构9年52例分析

宋继勇1，杜国盛1，朱志东1，郑德华1，石炳毅2   

  1. 解放军第309医院，1肝胆二科，2器官移植中心，北京市  100091
  • 收稿日期:2011-04-12 修回日期:2011-07-07 出版日期:2011-10-29 发布日期:2011-10-29
  • 通讯作者: 石炳毅，硕士，博士生导师，主任医师，解放军第309医院器官移植中心，北京市 100091 shibingyi@ medmail.com.cn
  • 作者简介:宋继勇★，1977年生，河北省保定市人，汉族，2001年解放军第三军医大学毕业，硕士，主治医师，主要从事肝脏移植的基础与临床研究。 sjy0723@sina. com

Extro-pulmonary bacterial infection after liver transplantation: An analysis of 52 cases from one institute during 9-year follow-up period

Song Ji yong1, Du Guo-sheng1, Zhu Zhi-dong1, Zheng De-hua1, Shi Bing-yi2   

  1. 1Second Department of Hepatobiliary Surgery, 2Organ Transplantation Center, the 309 Hospital of PLA，Beijing  100091, China
  • Received:2011-04-12 Revised:2011-07-07 Online:2011-10-29 Published:2011-10-29
  • Contact: Shi Bing-yi, Master, Doctoral supervisor, Chief physician, Organ Transplantation Center, the 309 Hospital of PLA，Beijing 100091, China shibingyi@medmail. com.cn
  • About author:Song Ji-yong★, Master, Attending physician, Second Department of Hepatobiliary Surgery, the 309 Hospital of PLA，Beijing 100091, China sjy0723@sina.com

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摘要：

背景：既往文献主要针对肝移植后肺部感染进行研究，而肺外感染研究较少。
目的：探讨肝移植后肺外细菌感染的危险因素，提出预防移植后肺外细菌感染方案和治疗策略。
方法：回顾性分析52例肝移植后发生肺外细菌感染的肝移植患者病历资料，归纳可能的危险因素，总结其发病特点、常见病原菌及治疗方案。
结果与结论：356例肝移植患者共发生肺外细菌感染52例，其中切口感染36例，腹腔感染13例，胆道感染6例，同时发生两个部位感染3例。培养出病原菌37例，其中单一病原菌感染32例，混合细菌感染5例。未发生因肺外细菌感染死亡病例。病原菌主要包括：铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、粪肠球菌、屎肠球菌等。其相关危险因素主要包括：移植过程中出血量超过10 000 mL、移植后胆道并发症、再移植、重度腹水、暴发性肝衰竭肝移植等。对于肝移植细菌感染的控制，预防重于治疗，感染发生后，需尽可能去除引起感染的病因，合理应用药物治疗。

关键词: 细菌感染, 肝移植, 危险因素, 病原菌, 器官移植

Abstract:

BACKGROUND: Bacterial infection after liver transplantation is one of the frequent complications. Although extro-pulmonary infection seldom threatens the lives of patients, extro-pulmonary infection after liver transplantation is significantly higher than that after other obdominal operations. Extro-pulmonary infection after liver transplantation aggravates patients’ suffering and prolongs the hospitalization period, so it remains an intractable clinical problem.
OBJECTIVE: To explore the risk factors of extro-pulmonary bacterial infection after liver transplantation and summarize the prevention and treatment programs for these patients.
METHODS: 52 extro-pulmonary bacterial infection patients who underwent liver transplantation were retrospectively analyzed. The risk factors, disease characteristics, common pathogenic bacterias and treatment prescription were summarized.
RESULTS AND CONCLUSION: Postoperative extro-pulmonary bacterial infection was diagnosed in 52 of 356 patients who underwent liver transplantation. There were 36 patients with infection of incisional wound, 13 patients with infection of abdominal cavity, 6 patients with infection of biliary tract in this group. Three patients were found with infection at two positions. Pathogenic bacterias were dectected in these patients. 32 patients suffered from single bacterial infection and five patients had combined bacterial infection. No patients died because of postoperative extro-pulmonary bacterial infection. The pathogenic bacterias included pseudomonas aeruginosa, escherichia coli, staphylococcus aureus, enterococcus faecalis, and enterococcus faecium. The possible risk factors included over 10 000 mL bleeding, biliary complication, retransplantation, fulminating hepatic failure and severe ascites receptors. These findings show that postoperative extro-pulmonary bacterial infection is one of common complications after liver transplantation. Timely detection, reasonable prevention and treatment can relieve patients’ pain and shorten hospitalization time period.

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