离体肝肿瘤切除余肝自体移植病人围术期护理

肝移植术被认为是治疗终末期肝病最有效的外科方法，肝移植技术在国内大型综合性医院也得到广泛的重视和发展，但由于供体缺口大，有许多终末期肝病病人来不及等到适合自己的供体就发生肝功能衰竭、肿瘤破裂出血等严重并发症而死亡。近几年，随着血管外科、冷灌注及冷保存技术的发展和成熟，     

离体肝切除联合余肝自体移植术病人的护理

自1988年德国汉诺威医学院Pichlmayer等[1]报道离体肝手术技术以来,肝胆外科医生开始有选择性地对一些常规方法不能切除的肝占位性病变采用离体肝切除及余肝自体肝移植的术式进行外科治疗,对于提高累及肝静脉和下腔静脉中央型肝肿瘤的切除率、解决异体肝移植供肝匮乏的问题具有重要意义。但由于该类手术技术难度大、风险高,因此发展比较缓慢,相关     

一例离体肝切除自体残肝移植术的护理配合

尽管扩大右肝和扩大左肝切除术目前已成为有经验的外科医师的较为标准的操作,但是肿瘤侵犯腔静脉以及肝静脉需要复杂的静脉修复或者同时侵犯肝静脉和肝蒂系统的病人,这种扩大肝切除术常不能满足治疗需要,在不适合肝移植或供肝匮乏的情况下,需要考虑行离体肝切除/自体肝移植.自1988年Pichlmayr[1]率先开展离体和低温肝灌注肝切除技术以来,离体肝切除/自体肝移植发展较慢,国内外普及较少.我们在总结11例同种异体原位尸体肝移植和2例成人活体肝移植经验的基础上,于2011年1月开展了1例离体肝切除/自体肝移植术,现将术中护理资料分析讨论如下.     

1例"两供一受"活体肝移植手术配合体会

肝脏移植是目前治疗终末期肝病最为有效的手段,但移植界多年来一直面临尸体供肝来源短缺的难题.为缓解受体需求和供体短缺之间的矛盾,20世纪末活体肝移植应运而生.在外科技术层面上,活体肝移植相对于尸体肝移植更加复杂、技术难度更高."两供一受"活体肝移植是指用两个供体的双左叶或一左叶一右叶供肝形成人活体肝移植手术,适用于体重较重的病人[1,2].     

1例“两供一受”活体肝移植手术配合体会

肝脏移植是目前治疗终末期肝病最为有效的手段,但移植界多年来一直面临尸体供肝来源短缺的难题。为缓解受体需求和供体短缺之间的矛盾,20世纪末活体肝移植应运而生。在外科技术层面上,活体肝移植相对于尸体肝移植更加复杂、技术难度更高。     

超长无肝期肝移植受者围手术期的治疗--附3例报告

肝移植术已经成为挽救终末期肝病患者的重要临床手段。为了挽救更多患者的生命和缓解供体短缺，临床医生会考虑使用边缘供体，这样就使肝移植围手术期发生移植肝原发无功能的几率明显增加。天津市第一中心医院移植中心自2002年至今共完成1253例肝脏移植，其中3例于移植术中发生移植肝原发无功能，我们在诊断明确后果断切除无功能的移植肝脏，     

小儿肝移植受体的选择和评估

肝移植是治疗小儿各种终末期肝病唯一有效的手段,经过数十年的发展,肝移植技术在国内外已日趋成熟。由于多种原因,国内小儿肝移植的发展滞后于成人肝移植,并且与成人比较,小儿肝移植有其自身的特点,反映在适应证、供体选择、手术技术难度、术后管理等方面均与成人有明显不同,如原发性胆道疾病和先天性代谢疾病占较大比例。本文就小儿肝移植受体的选择和评估作一文献综述     

儿童肝移植护理研究的进展

正随着肝移植领域外科技术的不断发展,儿童肝移植在手术技巧、麻醉管理、供肝的获取与保存、免疫抑制以及术后并发症的处理等方面不断改善,现已经成为儿童终末期肝病、肝功能衰竭、遗传代谢性肝病及常规治疗手段无效的肝脏恶性肿瘤的最佳治疗手段。本文旨在对当前儿童肝移植护理领域做一文献回顾,总结护理方面的经验及观点,为儿童肝移     

离体肝切除联合自体肝移植在特殊部位原发性肝癌根治术中的应用价值

目的 探讨离体肝切除联合自体肝移植在特殊部位原发性肝癌根治术中应用的安全性和有效性.方法 选取重庆医科大学附属第三医院2020年2月收治的1例尾状叶巨块型肝癌行离体肝切除联合自体肝移植的患者,回顾性分析该患者的临床资料及治疗过程.结果 患者手术顺利,术后肝功能逐渐恢复正常,未发生吻合口栓塞、肝脓肿等并发症,随访截至2020年12月(术后10个月)未发现明显门静脉高压及肿瘤复发征象.结论 离体肝切除联合自体肝移植可为风险巨大的中央型肝癌患者提供手术切除机会,短期疗效可,但临床推广及远期效果还需要进一步探索与循证医学的数据支持.     

半离体部分肝切除自体肝移植患者的术后重症监护

自1988年Pichlmayer报道肝脏离体手术技术以来，由于肝半离体和离体缺血灌注损伤问题、肝血流阻断后血流动力学和内环境紊乱问题、残肝能否代偿等问题，使半离体、离体肝切除自体肝移植技术一直发展缓慢。目前世界上掌握此技术的只有德国、美国、日本等几个少数国家，国内一直没有成功的先例。我院自2005年4月以来，采用半离体部分肝切除自体肝移植术治疗左肝叶复发性癌、肝右、     

肝移植后肝功能的异常★

背景：肝移植后导致肝功能异常原因复杂，早期弄清引起肝功能异常的原因对治疗至关重要。目的：较全面的了解肝移植后可以导致肝功能异常的原因，以便应用于临床诊治。方法：应用计算机检索CNKI和FMJS数据库，采用医学主题词检索，检索词为“肝移植；肝功能异常；转氨酶异常；胆红素升高；原因”或“liver transplantation；abnormal liver function；transaminase abnormalities；bilirubin increased, and causes”，时间范围为1991年1月至2012年7月，共检索到98篇文章，选择文章主要内容与肝移植后肝功能异常直接相关的、发表在权威杂志上的文章共35篇进行综述。结果与结论：肝移植后导致肝功能异常的原因众多，临床表现复杂。最常见的原因依次是急性排斥反应、胆道并发症及病毒感染。肝移植后早期，尤其是1个月内出现肝功能异常，需警惕小体积综合征和原发性移植物无功的发生。各种原因引起的肝功能异常，转氨酶及胆红素升高的程度不尽相同。急性排斥反应、自身免疫性肝炎、病毒感染、门静脉及肝静脉狭窄、缺血-再灌注损伤等转氨酶升高较胆红素升高显著；慢性排斥反应、胆道并发症、肝动脉狭窄、原发性胆汁性肝硬化、原发性硬化性胆管炎等早期以梗阻酶碱性磷酸酶、谷氨酰转移酶、总胆红素、直接胆红素升高为主；肿瘤导致的肝功能异常视肿瘤大小、压迫部位不同，可表现出以转氨酶升高为主或以胆红素升高为主。此外，各种原因多有其特殊病史，仔细询问病史有助于早期诊断。临床工作中，应重视尽量详尽的采集病史，根据转氨酶和胆红素升高的具体情况，首先考虑引起肝功能异常的常见原因，经临床证实排除后再考虑其他相对不常见原因，并结合实验室检查、影像学检查及肝脏穿刺病理活检，尽早明确病因及治疗。     

Acute liver failure: liver support therapies

PURPOSE OF REVIEW: We summarize the therapeutic approach to patients with acute liver failure with the main focus on bioartificial and artificial liver support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute liver failure. RECENT FINDINGS: Bioartificial liver support systems use hepatocytes in an extracorporeal device connected to the patient's circulation. Artificial liver support is intended to remove protein-bound toxins and water-soluble toxins without providing synthetic function. Both systems improve clinical and biochemical parameters and can be applied safely to patients. Although bioartificial liver-assist devices have not been shown to improve the survival of patients with acute liver failure, further development is underway. Artificial liver support systems have been shown to alter several pathophysiological mechanisms involved in the development of acute liver failure but survival data are still limited. SUMMARY: Mortality in patients with acute liver failure is still unacceptably high. The most effective treatment, liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal liver assist.     

Lipid peroxidation of the liver in liver disease

Material of puncture biopsy of the human liver left after morphological study was used to explore enzymatic and non-enzymatic lipid peroxidation, NADH-ferricyanide reductase activity, the content of triglycerides, cholesterol and protein. It was shown that the degree of lipid peroxidation varies considerably in different liver diseases. The highest degree of lipid peroxidation was discovered in patients with fibrosis accompanied by the symptoms of fatty dystrophy. It was established that the rate of peroxidation does not directly correlate with the level of liver lipid infiltration. It is concluded that NADH-ferricyanide reductase activity mirrors adequately the nature of a liver disease and can be used as a highly sensitive and very specific enzymatic test.     

Management of chronic liver failure until liver transplantation

Chronic liver failure is an important cause of morbidity and mortality and is the long-term consequence of many chronic liver diseases. In addition to determining the specific cause of the chronic liver disease, which may be amenable to targeted therapy, it is important to treat the sequelae of chronic liver failure effectively to improve quality of life, to prolong survival, and to provide a bridge to liver transplantation. Once a patient who has chronic liver failure develops hepatic decompensation, liver transplantation is the definitive treatment for those who qualify. Management of chronic liver failure is the focus of this article.     

晚期肝癌合并肝包膜下出血或肝破裂出血的护理

目的总结晚期肝癌并肝包膜下出血或肝破裂出血的护理要点。方法2001年1月~2004年12月对本院收治的56例晚期肝癌并肝包膜下出血或肝破裂出血病人进行抢救治疗,并配合护理。结果治疗总有效率为80.4%,死亡率为12.5%。结论晚期肝癌并肝包膜下出血或肝破裂出血,病情变化快,死亡率高,护理的重点在于止痛、止血、并发症的急救、病情观察,心理及支持性的护理,并开展健康教育,尽量消除各种诱发因素,有效地控制出血和防止再出血,从而提高病人的生活质量。     

Antipyrine kinetics in liver disease and liver transplantation

Antipyrine kinetics were studied in seven normal subjects, 10 patients with liver disease, and 13 clinically stable patients who received a liver transplant. Five patients were studied both before and after liver transplantation. Antipyrine concentrations in saliva after oral dosing were measured by HPLC. The antipyrine t1/2 was significantly longer (P less than 0.05) in patients with liver disease than in patients undergoing liver transplantation and normal subjects. Antipyrine clearance was not significantly different between patients undergoing liver transplantation and normal subjects, but it was significantly reduced (P less than 0.05) in patients with liver disease. In five patients who were studied before and after liver transplantation, there was a significant (P less than 0.05) increase in the antipyrine clearance and a marked reduction in its t1/2 after liver transplantation. These results indicate that liver transplantation improves the drug metabolizing ability of patients with liver disease and that the oxidative metabolizing capacity of the liver in clinically stable patients after liver transplantation is similar to that of normal subjects.