第七节生育问题
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《临床肝移植》
术前月经失调（闭经、月经量少、不规则出血等），术后8-9个月后可以恢复正常。肝移植术后怀孕生育也时有报道[49]。有人认为，肝移植术后女性完全可以恢复正常的生育能力，但早产和剖宫产的概率较高。在怀孕期间，免疫抑制应该正常使用，但要注意监测。至目前为止，还没有致畸的报道。怀孕及生育不会增加排异反应的危险[50]。由于口服避孕药会增加血液粘稠度，加重高血压及药物之间的反应，故肝移植术后病人不宜使用口服避孕药。
肝移植术后对男性生育能力的影响还未见报道。由于肝移植病人的下一代均未到生育年龄，因此对下一代生育能力有无影响也未见报道。
参考文献
1．Grieg PD,Woolf GM,Sinclair T et al.Treatment of primary Liver grafts nonfunction with prostaglandin E1.Transplantation,1989,48:447
2.Lange R,Erhard J,Rauen U et al.Determination of hepatocellular enzymes in effluent of human liver grafts for preoperative evaluation of transplant quality.Transplantation,1996,62:1255
3.Rela M,Muiesan P,Bhatnagar V et al
.Hepatic artery thrombosis after liver transplantation in children under 5years ofl age.Transplantation ,1996,61:1355
4.Drazan K,Shaked A,Olthof KM et al
.Etiology and management of symptomatic adult hepatic artery thrombosis after orthotopic liver transplantation(OLT).Am Surg,1996,62:237 5.Jurim O,Csete M,Gelabert HA et al.Reduced-sized graft-the solution for heparic artery thrombosis after pediatric liver transplantation?J Pediatr Surg,1995,30:53 6 Millis JM,Seaman DS,Piper JB et al.Portal vein thrombosis and stenosis in pediatric liver transplantation.Transplantation,1996,62:748 7 Bhatnagar V,Dhawan A,Chaer H et al.The incidence and management of biliary complications following liver transplantation in chhldren,Transpl Int,1995,8:38 8 Macfarlane B,Davidson B,Dooley JS et al.Endoscopic retrograde cholangiography in the diagnosis and endoscopic management op biliary complications.Eur J Gastroenterol Hepatol,1996,8:1003 9 Khong PL,Sreeram N,John PR.Metallic sterting of biliary free following liver transplant hepatic artery thrombosis in an infant.Pediatr Rediol,1997,27:79 10 Douzdjian V,Abecassis MM,Johlin FC.Sphincter of Oddi dysfunction following liver transplantation.Screening by bedside mainometry and definitive manometric evaluation.Dig Dis Sci,1994,39:253 11 Haagsma EB,Thijn CJ,Post JG et al.Bone disease after orthotopic transplantation,J Hepatol,1988,6:94 12 Stegall MD,Everson G,Schroter G et al.Metabolic complication after liver transplantation:diabetes,hypercholesterolemia,hypertension,and obesity,Transplantation,1995,60:1057 13 Paller MC.The prostaglandin E1 analogue,misoprostol analogue reverses acute cyclosporine nephrotoxicity.Transplant Proc,1988,20(Suppl 3):634 14 Wijdicks EF Wiesner RH,Krom RA.Neurotoxity in liver transplant recipients with cyclosporine immnosuppression.Neurology,1995,45:1962 15 Kabeer MH,Filo RS,Milgrom ML et al.Central pontine myelinolysis following orthotopic liver transplantation:association with cyclosporine toxicity.Postgrad Med J,1995,71:834;71:239 16 Fryer JP,Fortier MV,Metrakos P et al.Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation,Transplantation,1996,61:658 17 Falagas ME,snydman DR,Griffith J et al.Effect of cytomegalovirus infection status or first-year mortality.Boston Center for Liver Transplantation CMV IgG Study Gfroup.Ann Intern Med,1997,126:275 18 Vandenberg AP,Klompmaker IJ,Haagsma EB et al.Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection,Clin Transplant,1996,10:224 19 Falagas ME,Snydman DR,Ruthaxer R et al.Primary cytomegalovirus infection in liver transplant recipients:comparison of infections transmitted via donor organs and via transfusions.Boston Center for liver Transplantation CMV IgG Study Group.Clin Infect Dis,1996,23:292 20 Winston DJ,wirin D,Shaked A et al.Randomized comparison of gancyclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in liver transplant recipients.Lancet.1995,346:8967 21 Kanj SS,Sharara AI,Clavien PA et al.Cytomegalovirus infection following liver transplantation:review of the literature.Clin Infect Dis,1996,22:537 22 Stratta RJ,Shaefer MS,Cushing KA et al.A randomized prospective trial of acyclovir and immune globulin prophylaxis in liver transplant recipients receiving OKT3 therapy,Arch Surg,1992,127:55 23 Liebau P,Kuse E,Windler M er al.Management of herpes simples virus type l pneumonia following liver transplantation,Infection,1996,24:130 24 Lumbreras C,Cuervas-Mons V,Jara P et al,Randomized study of candida infection following liver transplantation,J Infect Dis,1996,174;583 25 Torre-C,Cuervas-Mons V,Jara P et al.Effective of daily low-dose cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia in liver transplantation- an open clinical trail.Transplantation,1996,62:1519 26 Lynch SV,Strong RW.Primary cirrhosis:does it recur after transplantation?J Gastroenterol Hepatol,1989,4:109 27 Anon.Is PBC cured by liver transplantation?Lancet,1991,337:272 28 Knoop M,Bechstein WO,Schrem H et al.Clinical Significance of recurrent primary biliary cirrhosis after liver transplansplantation.Transpl Int,1996,9(Suppl 1):S115 29 Van DE Water J,Gerson LB,Ferrell LD et al.Immunohistochemical evidence of disease recurrence after liver transplantation for primary biliary cirrhosis.Hepatology,1996,24:1079 30 Sebagh M,Farges O,Kalil A etal.Sclerosing cholangitis following human orthotopic liver transplantation.Am J Surg pathol,1995,19:81 31 Devlin J,Donaldson P,Portmann B et al.Recurrence of autoimmmune hepatitis following liver transplantation,Liver Transplant Surg,1995,1:162 32 O＇Grady JG,Williams R,Liver transplantation for viral hepatitis.Br Med Bull,1990,46:481 33 Hart J,Busuttil RW,Lewin KJ.Disease recurrence following liver transplantation.Am J Surg Pathol,1990,14(Suppl 1):79 34 Terrault NA,Zhou S,Combs C et al.Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis Bimmunoglobulin. Hepatology,1996,24:1327 35 McGory RW,Ishitani MB,Oliveira WM et al.Imprived ortcome of orthotopic liver transplantation for chromic hepatitis B cirrhosis with aggressive passive immunization.Transplantation,1996,61:1358 36 Bain VG,Kneteman NW,Ma MM et al.Efficacy of lamivudine im chronic hepatitis B patients with active viral replication and decompensated cirrhosis undergong liver transplantation,Transplantation,1996,62:1456 37 Grdllier L,Mutimer D,Ahmed M et al.Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis.Lancet,1996,348:9036 38 Ben-Ari Z,Shmueli D,Mor E et al.Beneficial effect of lamivueine in recurrent hepatitis B after liver transplantation.Transplantation,1997,63:393 39 Bartholomew MM,Jansen RW,Jeffers LJ et al.Hepatitis-B-virus resistance to lamivudine given for recurrent infection after orthotopic liver transplantation.Lancet,1997,349:9044 40 Gish RG,Lau JY,Brook L at al.Gancyclovir treatment of hepatitis B virus infection in liver transplant recipients.Hepatology,1996,23:1 41 Boker KH,Ringe B,Kroger M et al.Prostaglandin plus famciclovir-a new concept for the treatment of sever hepatitis B after liver transplantation. Transplantation,1994,57:1706 42 Haller GW,Bechstein WO,Neuhaus R et al.Famciclivir therapy for recurrent hepatitis B infection after transplantation.Transpl Int,1996,9(Suppl 1):S210 43 Neuhaus P,Steffer R,Blumhardt G et al.Experience with immunoprophylaxis and interferon therapy after liver transplantation in HBsAg-positive patients.Transplant Proc,1991,23:1522 44 Cavallari A,Vivarelli M,D’Errico A et al.Fatal necrotizing pancreatitis caused by hepatitis B infection in a liver transplant recipients.J Hepatol,1995,22:685 45 Schluger LK,Sheiner PA,Thung SN et al.Severe recurrent cholestatic hepatitis C following orthotopic liver transplantation.Hepatology,1996,23:971 46 Gane EJ,Tibbs CJ,Ramage JK et al.Ribavirin therapy for hepatitis C infection following liver transplantation.Transpl Int,1995,8:61 47 Cattral MS,Krajden M,Wanless IR et al.A pilot study of ribavirin therapy for recurrent hepatitis C virus infection after liver transplantation.Transplantation,1996,61:1483 48 Feray C,Samuel D,Gigou M et al.An open trial of interferon alfa recombinant for hepatitis C after liver transplantation:antiviral effects and risk of rejection.Hepatology,199,22:1084 49 Skannal DG,Dunngy-Poythress LJ,Miodovnik M et al.Pregnancy in a combined liver and kidney transplant recipient with type
1 primary hyperosaluria.Obstet Gynecol,1995,86:641 50 Laifer SA,Guido RS.Reproductive function and outcome of pregnancy after liver transplantation in women.Mayo Clin Proc,1995,70:388 51 Killenberg PG,Clavien PA.Medical care of the liver transplant patient Massachusetts:Blackwell Sciemce Inc,1997:159, http://www.100md.com