终末期肝病模型在肝病中的应用进展

终末期肝病模型(modelforend-stageliverdisease,MELD)是近年来新创立的判断晚期肝病病情的方法,最初他是用于评估行经颈静脉肝内门体分流术(transjugularintrahepaticportosystemicshunt,TIPS)后患者的生存率,目前已被广泛应用于肝移植、终末期肝病患者预后、评估肝癌患者术后(手术切除癌灶或局部治疗等)生存率等方面,现认为MELD模型可以有效的预测终末期肝病患者的预后,能准确的反映病情的危急程度.     

终末期酒精性肝病的肝移植

西方国家常见的酒精性肝病（ALD）近年来在我国也有明显的增加.由于没有疗效确切的药物,肝移植成为目前治疗终末期酒精性肝病（EALD）最有效的手段,而与其他良性终末期肝病肝移植比较,EALD肝移植存在诸多特殊的临床问题.我们回顾分析我院11例EALD肝移植的临床资料及随访结果,对受者的选择、术前的评估及围手术期的处理等问题进行探讨.     

HBV相关肝病肝移植及移植后乙型肝炎复发的防治

肝移植作为HBV相关肝病患者的治疗曾被许多学者置疑,原因就是HBV感染复发导致肝脏再次损伤,发生纤维淤胆性肝炎和肝硬化,最终导致肝功能衰竭。近10年,抗病毒药物和免疫疗法的普遍采用,大大提高了受体的远期疗效,使HBV相关的终末期肝病和其他病因的终末期肝病一样成为肝移植最好的适应证之一。研究表明,乙型肝炎肝硬化失代偿患者用非移植方法治疗1年、5年、     

肝脏移植概述

肝脏移植是治疗终末期肝病的根本方法,其适应证包括良性终末期肝病、肿瘤性疾病和先天性、代谢性肝病。肝脏移植术式包括经典原位肝移植、背驮式肝移植和腔静脉成形式肝移植等。术后要防治并发症,控制排异反应,乙型肝炎患者要控制乙型肝炎,肝癌患者要防止肿瘤复发。     

丙型肝炎相关肝病肝移植后丙型肝炎复发的防治

肝移植是慢性丙型肝炎相关终末期肝病惟一的有效治疗方法，但所有患者均可能出现移植后丙型肝炎复发，移植后5年内约25％～33％的患者可因丙型肝炎复发出现肝硬化，因此对其预防和治疗尤为重要，本文就丙型肝炎相关肝病肝移植后丙型肝炎复发的防治作一介绍。     

MELD评分在终末期肝病中的应用

终末期肝病模型(MELD)是主要应用血清胆红素、国际标准化比值和血清肌酐指标来评价终末期肝病病情严重程度及预后的评分系统。其在预测终末期肝病短、中期死亡率及肝移植病例选择、移植器官的管理应用中已渐趋成熟,应用范围开始扩大到重型肝炎和原发性肝癌。部分学者针对腹水、血钠浓度等影响终末期肝病预后的因素也做了相关研究,对MELD评分系统进行了补充和完善。     

双肝移植的临床应用进展

亚洲是乙型肝炎流行高发区,有众多的终末期肝病患者,而肝移植是目前治疗终末期肝病最为有效的手段。由于受传统文化、伦理道德观等观念的影响,尸体器官捐献率一直比较低,器官供需之间的矛盾使得活体肝移植成为挽救终末期肝病患者的重要治疗手段。 双肝移植即一个受体同时接收两个供体的部分肝脏。目前双肝移植绝大多数为活体肝移植。韩国 Lee 等首先报道了双肝移植技术［1］,从两个活体捐献者获得两个肝左叶移植给一个患者。双肝移植由于减少了供体捐肝体积最大程度上保证了供体的安全。     

肝病细胞疗法的研究进展

肝病的细胞疗法主要用于急、慢性肝功能衰竭和终末期肝病.自上世纪80年代以来,肝移植成为治疗肝功能衰竭和终末期肝病的金标准,但供肝匮乏、费用高以及术后并发症等严重制约肝移植的深入发展.在此形势下,以细胞移植和生物人工肝(bioartificial liver system,BAL)为代表的细胞疗法为治疗肝脏疾病开辟了一条新途径.     

自体骨髓干细胞移植治疗重症肝病的最新进展

自体骨髓干细胞移植治疗肝衰竭 原位肝移植和肝干细胞移植均为终末期肝病有效的治疗手段，但前者因供肝来源有限、终身免疫抑制剂的应用等，使原位肝移植的临床应用受到限制，肝干细胞移植目前虽然尚不能取代原位肝移植，但因其取之于患者自身，不存在免疫排斥反应，且创伤小，治疗费用低，成为当前研究热点。[第一段]     

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随着移植学突飞猛进的发展,肝移植被广泛应用于治疗终末期肝病,并成为目前治疗终末期肝病的最有效方法。我国是肝病大国,肝病患者超过3000万,90%肝移植患者与乙型肝炎(简称“乙肝”)病毒(HBV)感染有关;尚有部分肝移植患者与丙型肝炎(简称“丙肝”)病毒(HCV)感染相关。本文就国内外防治肝移植术后肝炎复发的进展及存在的问题进行探讨。1预防肝移植后肝炎复发的重要性在我国,与肝炎病毒感染相关的急慢性肝病是肝移植的主要适应证,肝移植后肝炎复发是影响肝移植术后长期存活率的主要因素之一,肝移植受体带毒状况严重影响肝脏移植的肝炎复发…     

Implication of normal liver enzymes in liver disease

Summary.  Chronic liver disease is usually asymptomatic until its late stages and also significant hepatic necroinflammation and fibrosis may be present in persistently normal ALT levels HBV, HCV carriers or similarly, in patients with nonalcoholic fatty liver disease. Given the large number of persons in the general population which may harbor a clinically significant liver disease behind the screen of normal alanine aminotransferase, more attention should be devoted to future research for alternative noninvasive markers of liver damage.     

Pulmonary aspects of liver disease and liver transplantation

This article has summarized the liver-lung relationships from a clinical perspective. The physiology, biochemistry, and molecular biology that link the two organs are of great importance in that many disorders described affect young patients. Indeed, pulmonary abnormalities in patients with hepatic disorders are frequent, and both the pulmonary and hepatic problems may be reversible in the current era of organ transplantation.     

Results of liver resection for primary liver cancer

At the Zhong Shan Hospital, Shanghai Medical University, between 1960 and 1991, liver resection was performed in 896 patients with primary liver cancer; local resection was performed in 552 patients (61.6%), left lateral segmentectomy in 114 (12.7%), left hemihepatectomy in 157 (17.5%), extended left hemihepatectomy in 19 (2.1%), right hemihepatectomy in 50 (5.6%), and extended right hemihepatectomy in 4 (0.4%). The overall operative mortality was 4.6%, but it was 22.0% in 1960–1970, 7.0% in 1971–1980, and 2.8% in 1981–1991. Encouraging changes in the prognostic pattern were observed when comparing the data for 1960–1970 (n=59), 1971–1980 (n=115), and 1981–1991 (n=722): the 5-year survival rate was 14.0%, 36.0%, and 50.8%, respectively, and the 10-year survival rate was 12.3%, 25.5%, and 40.8%, respectively. Significant differences in survival patterns were noted when these were analyzed on the basis of tumor size (≤5 vs >5cm), curative resection, tumor number, tumor capsule, and tumor emboli in the portal vein. In the entire series, 135 patients have survived for more than 5 years after resection, and 40 patients for more than 10 years after resection. One patient has survived for 32 years and is still alive, free of disease. The approaches to decreasing operative mortality and prolonging survival rate are discussed.     

Role of liver transplantation in acute liver failure

Orthotopic liver transplantation is employed as salvage therapy for individuals who are unable to recover from acute liver failure. Prognostic models are helpful but not entirely accurate in predicting those who will eventually require liver transplantation. There are specific criteria for United Network for Organ Sharing category 1a (urgent) listing of these patients. Unfortunately, clinical deterioration develops rapidly and many require removal from the waiting list prior to transplantation. With advances in critical care management and surgical technique, 1-year post-transplant survival rates have improved to 60 to 80%. Alternatives to conventional orthotopic liver transplantation include living donor liver transplantation, ABO-incompatible grafts, and auxiliary liver transplantation. There are many ethical and psychosocial issues inherent to transplanting these sick patients due to the urgent nature of acute liver failure. Fortunately, the long-term survival and quality of life in these transplant recipients is good.