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肝移植治疗儿童毒蕈中毒并多脏器衰竭1例并文献复习

Liver transplantation for treatment of mushroom poisoning complicated with multiple organ dysfunction syndrome : a case report and literature review

摘要:

目的:报道1例应用肝移植治疗毒蕈中毒并多脏器衰竭的儿童病例,探讨应用肝移植技术治疗儿童毒蕈中毒的手术效果及远期预后。方法:回顾性分析2017年6月郑州大学第一附属医院儿科收治的1例毒蕈中毒患儿的临床资料,常规治疗不理想情况下行同种原位肝移植治疗,并进行文献复习,评估肝移植治疗儿童毒蕈中毒的有效性及可行性。结果:患儿,男,2岁,术前Child-pugh分级C级,手术过程顺利,术后恢复良好,术后1周黄疸消退,肝酶下降,凝血功能明显好转,复查头颅磁共振成像存在脑萎缩及脑室扩张,术后规律随访2年,患儿智力运动等各项发育指标明显落后于健康同龄儿。结论:毒蕈中毒导致暴发性肝衰竭是儿童接受肝移植治疗的适应证,同种原位肝移植治疗是治疗毒蕈中毒的有效方法,可有效改善患儿肝功能、代谢紊乱、凝血功能等指标,但毒蕈中毒所致神经系统损伤是不可逆的,肝移植技术治愈了患儿的肝衰竭,但仍遗留了严重的神经系统后遗症。

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abstracts:

Objective:To report 1 case of mushroom poisoning complicated with multiple organ dysfunction syndrome treated by liver transplantation, so as to explore surgical effectiveness and prognosis of liver transplantation on children mushroom poisoning.Methods:Retrospectively analyzed a child with mushroom poisoning who was admitted to the First Affiliated Hospital of Zhengzhou University in June 2017.Conventional treatment was not ideal, the child was conducted orthotopic liver transplantation.The effectiveness was evaluated and the feasibility of liver transplantation in treating children mushroom poisoning with literatures was reviewed.Results:A male 2-year old child obtained, preo-perative Child-pugh class for C. This child recovered well postoperatively, the jaundice disappeared, and liver enzyme and blood coagulation function improved significantly within 1 week after liver transplantation.However, the head magnetic resonance imaging presented brain atrophy and ventricular expansion, with intelligence and athletic ability being significantly behind his peers through postoperative regular follow-up for 2 years.Conclusion:Fulminant hepatic failure that was caused by mushroom poisoning is an indication for liver transplantation, and orthotopic liver transplantation is an effective method for the treatment of mushroom poisoning, which can effectively improve liver function, metabolic disorders and blood coagulation function for children with mushroom poisoning, but nervous system damage that was caused by mushroom poisoning is irreversible.Although liver transplantation technology successfully cured liver failure, it still left severe neurological sequelae.

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作者: 田喜艳 [1] 刘玉峰 [2] 马威 [1] 张建江 [2]
期刊: 《中华实用儿科临床杂志》2020年35卷19期 1496-1498页 ISTICPKUCA
栏目名称: 临床应用研究
DOI: 10.3760/cma.j.cn101070-20190821-00778
发布时间: 2020-11-16
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