实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2015年
1期
35-39
,共5页
王腾飞%张威%方振宇%王洪海%杨涛
王騰飛%張威%方振宇%王洪海%楊濤
왕등비%장위%방진우%왕홍해%양도
肝移植%颅内曲霉菌感染%手术切除
肝移植%顱內麯黴菌感染%手術切除
간이식%로내곡매균감염%수술절제
Liver transplantation%Intracranial aspergillosis%Surgical resection
目的：探讨肝移植术后曲霉菌感染及颅内曲霉菌感染患者的病因、临床表现、诊断及治疗。方法回顾性分析天津市第一中心医院1例经典原位肝移植术后并发颅内曲霉菌感染患者的临床资料、诊断及治疗经过，并进行文献复习。结果患者于移植术后1个月无明显诱因出现肌肉抽搐，抽搐时意识清晰，磁共振成像（MRI）提示：右侧额叶可见占位病变，病灶中心呈长T1长T2信号影，周围可见环形等T1短T2信号影，增强后病灶呈环形强化，中心未强化，周围低密度影未见强化，诊断为颅内曲霉菌感染。患者停用吗替麦考酚酯（MMF）及激素，单用他克莫司（FK506）抗排斥反应，且FK506血药浓度维持在较低水平，同时应用卡泊芬净抗真菌治疗，2周后查头颅MRI见右侧额叶脓肿无明显变化。为治愈颅内感染，患者于全麻下行右额叶脓肿切除术，术中可见坚韧的脓肿壁，大小约1.5 cm×2.0 cm，脑脓肿完整切除后送病理，术后病理回报：颅内曲霉菌感染。术后继续给予卡泊芬净抗真菌治疗，并定期复查头颅CT。颅内脓肿切除术后患者未再发抽搐、高热。术后1个月复查头颅CT显示，颅脑术后改变较前好转，右侧额颞部皮下组织肿胀较前减轻，其他无异常。患者痊愈后出院。结论由于颅内曲霉菌感染抗真菌药往往在局部难以达到有效的抑菌浓度，对于肝移植术后孤立的颅内曲霉菌感染病灶，联合应用局部手术切除和抗真菌药物，同时减少抗排斥反应药物的剂量，可能是理想的治疗方案。
目的：探討肝移植術後麯黴菌感染及顱內麯黴菌感染患者的病因、臨床錶現、診斷及治療。方法迴顧性分析天津市第一中心醫院1例經典原位肝移植術後併髮顱內麯黴菌感染患者的臨床資料、診斷及治療經過，併進行文獻複習。結果患者于移植術後1箇月無明顯誘因齣現肌肉抽搐，抽搐時意識清晰，磁共振成像（MRI）提示：右側額葉可見佔位病變，病竈中心呈長T1長T2信號影，週圍可見環形等T1短T2信號影，增彊後病竈呈環形彊化，中心未彊化，週圍低密度影未見彊化，診斷為顱內麯黴菌感染。患者停用嗎替麥攷酚酯（MMF）及激素，單用他剋莫司（FK506）抗排斥反應，且FK506血藥濃度維持在較低水平，同時應用卡泊芬淨抗真菌治療，2週後查頭顱MRI見右側額葉膿腫無明顯變化。為治愈顱內感染，患者于全痳下行右額葉膿腫切除術，術中可見堅韌的膿腫壁，大小約1.5 cm×2.0 cm，腦膿腫完整切除後送病理，術後病理迴報：顱內麯黴菌感染。術後繼續給予卡泊芬淨抗真菌治療，併定期複查頭顱CT。顱內膿腫切除術後患者未再髮抽搐、高熱。術後1箇月複查頭顱CT顯示，顱腦術後改變較前好轉，右側額顳部皮下組織腫脹較前減輕，其他無異常。患者痊愈後齣院。結論由于顱內麯黴菌感染抗真菌藥往往在跼部難以達到有效的抑菌濃度，對于肝移植術後孤立的顱內麯黴菌感染病竈，聯閤應用跼部手術切除和抗真菌藥物，同時減少抗排斥反應藥物的劑量，可能是理想的治療方案。
목적：탐토간이식술후곡매균감염급로내곡매균감염환자적병인、림상표현、진단급치료。방법회고성분석천진시제일중심의원1례경전원위간이식술후병발로내곡매균감염환자적림상자료、진단급치료경과，병진행문헌복습。결과환자우이식술후1개월무명현유인출현기육추휵，추휵시의식청석，자공진성상（MRI）제시：우측액협가견점위병변，병조중심정장T1장T2신호영，주위가견배형등T1단T2신호영，증강후병조정배형강화，중심미강화，주위저밀도영미견강화，진단위로내곡매균감염。환자정용마체맥고분지（MMF）급격소，단용타극막사（FK506）항배척반응，차FK506혈약농도유지재교저수평，동시응용잡박분정항진균치료，2주후사두로MRI견우측액협농종무명현변화。위치유로내감염，환자우전마하행우액협농종절제술，술중가견견인적농종벽，대소약1.5 cm×2.0 cm，뇌농종완정절제후송병리，술후병리회보：로내곡매균감염。술후계속급여잡박분정항진균치료，병정기복사두로CT。로내농종절제술후환자미재발추휵、고열。술후1개월복사두로CT현시，로뇌술후개변교전호전，우측액섭부피하조직종창교전감경，기타무이상。환자전유후출원。결론유우로내곡매균감염항진균약왕왕재국부난이체도유효적억균농도，대우간이식술후고립적로내곡매균감염병조，연합응용국부수술절제화항진균약물，동시감소항배척반응약물적제량，가능시이상적치료방안。
Objective To investigate the etiology,clinical presentation,diagnosis and treatment of Intracranial aspergillosis after liver transplantation. Methods Clinical data, diagnosis and treatment of one case with intracranial aspergillosis after liver transplantation were analyzed and correlative literatures were reviewed. Results The patient suffered muscle twitching without obvious cause one month after liver transplantation with clear consciousness. Magnetic resonance image(MRI)of head showed space-occupying lesion with long T1 long T2 signal in the centre and iso T1 short T2 signal around in the right frontal lobe. After enhancing,the lesion showed ring-enhancement with center and low density shadow around no reinforced. Intracranial aspergillosis was diagnosed. Then monotherapy of tacrolimus(FK506)was used with withdrawl of mycophenolate mofetil(MMF)and glucocorticoid. The serum FK506 concentration was maintained at a low level,and caspofungin was administrated for intracranial aspergillosis. The MRI of head showed no obvious changing in the right frontal lobe abscess after two weeks. In order to cure the intracranial infection,the patient underwent resection of the right frontal lobe abscess after general anesthesia. During the operation,an abscess with tough wall with the size of 1.5 cm×2.0 cm was seen,which was sent to the Department of Pathology after resection. The pathological findings revealed intracranial aspergillosis. After operation,we continued to administrate caspofungin to treat intracranial aspergillosis,and reviewed head CT scan regularly. The patient did not suffer recurrent convulsion and high fever after resection. One month later, head CT scan showed better postoperative brain change and the subcutaneous tissue swelling of the right cranial frontal reduced without other abnormalities. Then the patient was discharged after recovery. Conclusion Due to intracranial aspergillosis infection,it is difficult to achieve effective inhibitory concentration of antifungal agent. So when the transplant recipient was infected with isolated intracranial aspergillosis,combining local resection with antifungal agent and reducing the dose of anti-rejection drugs may be the ideal treatment.
