上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (2): 257-261.doi: 10.3969/j.issn.1674-8115.2021.02.021

• 综述 • 上一篇    

肝移植治疗慢加急性肝衰竭研究进展

张天翼(), 于也萍, 夏强, 杭化莲()   

  1. 上海交通大学医学院附属仁济医院肝脏外科,上海 200127
  • 收稿日期:2020-06-01 出版日期:2021-02-28 发布日期:2021-03-11
  • 通讯作者: 杭化莲 E-mail:949728601@qq.com;hanghualian@shsmu.edu.cn
  • 作者简介:张天翼(1997—),男,本科生;电子信箱:949728601@qq.com
  • 基金资助:
    国家自然科学基金面上项目(81570561);上海市教育委员会高峰高原学科建设计划(20181806);上海市重中之重临床医学中心(2017ZZ01018);上海交通大学医工交叉重点项目(YG2021ZD10)

Research progress in liver transplantation for acute-on-chronic liver failure

Tian-yi ZHANG(), Ye-ping YU, Qiang XIA, Hua-lian HANG()   

  1. Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2020-06-01 Online:2021-02-28 Published:2021-03-11
  • Contact: Hua-lian HANG E-mail:949728601@qq.com;hanghualian@shsmu.edu.cn
  • Supported by:
    National Natural Science foundation of China(81570561);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20181806);The Most Important Clinical Medical Center in Shanghai(2017ZZ01018);Shanghai Jiao Tong University Medical Engineering Cross Grant(YG2021ZD10)

摘要:

慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)指在慢性肝病的基础上由各种损伤因素引发的急性肝功能失代偿。该病常伴肝外器官衰竭且短期死亡率极高。目前ACLF缺乏有效的治疗手段,肝移植手术是唯一有潜在治愈概率的治疗方式。肝移植的术前评估十分重要。我国由于乙型肝炎病毒(hepatitis B virus,HBV)感染群体基数较大,需着重考虑HBV相关ACLF的术前情况,并根据COSSH-ACLF、CLIF-ACLF等评分对患者术前情况进行评估。手术时机方面,在患者处于ACLF2级时进行肝移植也许能够提高患者生存获益,但相关结论需要进一步的研究讨论。围手术期主要以病因处理以及多器官衰竭处理为主。术中则需要注意合理安排供体修整和受体游离的时间安排。术后除了肝移植常规并发症外,还需注意感染、肝性脑病、器官衰竭等ACLF相关并发症的处理。术前与术后的器官衰竭情况均与患者长期预后相关。该文结合笔者所在科室大量ACLF肝移植实际工作经验,在查阅大量文献的基础上,就ACLF肝移植术前评估、手术时机选择、围手术期管理、术中注意事项、术后并发症以及长期预后作一综述。

关键词: 慢加急性肝衰竭, 肝移植, 多器官衰竭, 死亡率, 并发症

Abstract:

Acute-on-chronic liver failure (ACLF), caused by various factors, is a rapid decompensation of liver function based on chronic liver disease, which is often accompanied by multiple organ failure and high short-term mortality. So far, there is no effective treatment except liver transplantation, which is the only possible cure. The evaluation before surgery is critical. Due to the large amount of hepatitis B virus (HBV) patients in our country, the evaluation of HBV-related ACLF (HBV-ACLF) is important. Systems like COSSH-ACLF, and CLIF-ACLF could be used for the evaluation. For the timing of surgery, transplantation at the state of ACLF-2 may have more benefit for patients but the conclusion need more research to prove. During the perioperative period, management of organ failure and basic disease is needed. The timing of dissociation of the receptor and trimming of the donor need to be carefully managed during the surgery. After the surgery, beside the usual complication of liver transplantation, events such as infection, organ failure, hepatic encephalopathy should be dealt with. The condition of organ failures before and after liver transplantation is associated with the long-term mortality of patients.This article aims to make review on the assessment before liver transplantation, timing of transplantation, perioperative management, notice during surgery and complication after surgery based on massive clinical experience and plenty of document readings.

Key words: acute-on-chronic liver failure (ACLF), liver transplantation, multiple organ failure, mortality rate, complication

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