一、禁忌證
如果病人合并有下列疾病，應(yīng)視為手術(shù)禁忌證。
�。�1)血清中人類免疫缺陷病毒（HIV)陽(yáng)性。
�。�2)肝外惡性腫瘤。
�。�3)膽管癌。
�。�4)嚴(yán)重的心肺疾病。
（5)未控制的全身性感染。
�。�6)其他臟器功能衰竭。
�。�7)心理學(xué)方面的不適應(yīng)。
二、危險(xiǎn)因素
肝移植的主要危險(xiǎn)因素包括：年齡偏大、肌營(yíng)養(yǎng)不良、昏迷、腹水、活動(dòng)性出血和既往有腹部手術(shù)史等。表3-1為Pittsburgh的術(shù)前評(píng)估表，可用來(lái)粗略預(yù)測(cè)肝移植術(shù)后病人的存活率。
表3-1 肝移植受體術(shù)前評(píng)估表
| 分?jǐn)?shù) | 表現(xiàn) | 分?jǐn)?shù) | 表現(xiàn) | ||
| 昏迷 | 6 | 術(shù)中為昏迷狀態(tài) | 腹水 | 2 | 難控制型 |
| 2 | ⅢⅣ期昏迷 | 1 | 可控制型 | ||
| 1 | 間歇性意識(shí)不清 | 0 | 無(wú) | ||
| 0 | 無(wú)肝性腦病 | 其他 | 2 | 膽紅素300µmol/L | |
| 肌營(yíng)養(yǎng)不良 | 2 | 重度肌營(yíng)養(yǎng)不良 | 1 | 曲張靜脈出血 | |
| 1 | 輕度肌營(yíng)養(yǎng)不良 | 1 | 膽管系統(tǒng)感染 | ||
| 0 | 無(wú)肌營(yíng)養(yǎng)不良 | 1 | 自發(fā)性腹膜炎 | ||
| 既往手術(shù)史 | 2 | 多次膽管再建手術(shù) | 2 | 年齡大于40歲 | |
| 2 | 門(mén)腔靜脈分流術(shù) | 1 | 膽紅素100µmol/L | ||
| 1 | 每次開(kāi)腹術(shù) | 1 | PT15 s | ||
| 0 | 無(wú) |
本表應(yīng)用比分累計(jì)法，0-3分表示低危病人，如果等于或高于7分，意味著存在著比3分病人高1倍的危險(xiǎn)性。單一的因素如術(shù)后出血等，與術(shù)后病人的存活率也明顯相關(guān)。既往腹有手術(shù)史，特別是膽管手術(shù)史，將明顯增加手術(shù)的難度。
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