原位肝移植术后真菌感染的诊治

目的 探讨原位肝移植术后真菌感染的诊断和治疗。方法 58例肝移植患者术后怀疑真菌感染时，行体液（痰、血、尿、胆汁、引流液等）或导管真菌培养，结合胸腹部CT影像学检查、活组织检查及诊断性治疗结果综合判断，一旦诊断确定，即给予氟康唑治疗，无效者改用伊曲康唑和两性霉素B，同时调整免疫抑制治疗方案。结果 58例患者中，16例术后并发真菌感染21例次（5例患者发生两次以上、不同部位或不同菌株的感染），感染发生率为27．6％（16／58），感染发生在术后4～38d，感染好发部位依次为肺（28．6％）、肠道（19．0％）、泌尿系统（14．3％）、腹腔（14．3％）、切口（9．5％）、血液（4．8％）、胆管（4．8％）及肝脏（4．8％）。在21例次真菌感染中，念珠菌感染占85．7％，曲霉菌感染占14．3％。氟康唑治疗有效者占66．7％，伊曲康唑治疗有效者占14．3％，两性霉素B治疗有效者占14．3％，1例（4．7％）各种抗真菌药物治疗均无效，治疗总有效率为95．2％。结论 肝移植术后真菌感染的发生率较高，依据影像学检查、病原学检查及活组织检查综合判断真菌感染，及时选用氟康唑、伊曲康唑及两性霉素B治疗。

Diagnosis and treatment of fungal infection after orthotopic liver transplantation

Objective To investigate the diagnosis and treatment of fungal infection after orthotopic liver transplantation (OLT).Methods The clinical data of 21 cases of fungal infection were analyzed in 58 cases after OLT. Fungal infection was diagnosed by examining funga in blood, fluid, sputum, urine and stool of patients as well as image examination (such as chest or abdominal CT scan).Results Twenty-one case-times of fungal infection were diagnosed in 16 cases (5 cases having diffe- rent locations and fungal strains more than two frequency). Candida strain infection was diagnosed in 18 cases ( 85.7 % ), Aspergillus strain infection in 3 cases ( 14.3 % ). Lung fungal infection was found in 6 cases ( 28.6 % ), intestine in 4 cases (19 %), urinesystem in 3 cases ( 14.3 % ), abdominal cavity in 3 cases ( 14.3 % ), incision in 2 cases ( 9.5 % ), blood in one case ( 4.8 % ), bile duct in one case ( 4.8 % ) and liver in one case ( 4.8 % ). Fungal infection occurred after OLT from 4 to 38 days (mean 18 days) and infection rate was 27.6 % (16/58). Thirteen of 16 cases were cured with antifungal agents with the curative rate being 81.2 % , and 3 cases were dead with mortality being 18.8 % . Fourteen cases were effectively treated with fluconazole, 3 cases with itraconazole, 3 cases with liposomal amphotericin B, but one case could not effectively treated with various anti-fungal agents, with the total effective rate being 95.2 % .Conclusion Fungal infection is one of important causes influencing survival rate after OLT. Imaging, pathogenic and biopsy examinations could be done to early diagnose fungal infection. Funcgal function could be timely treated with effective antifungal agents (such as fluconazole, itraconazole, liposomal amphotericin B).