小肝综合症的发生机制与防治(2)
减体积肝移植术后,针对持续性门脉高压和过度门脉灌注的治疗,可以减少小肝综合症及相关症状的发生。有研究表明,在小肝综合症或者术后肝功能衰竭患者中通过门静脉血浆置换(PP)加体外连续门静脉分流(ECPD),可以有效减轻肝脏毒性负荷和高灌注损伤[16]。Karvellas CJ等[17]研究发现,当出现急性肝衰竭时,低温治疗虽然没有增加远期生存率及肝移植成功率,但其对年轻的急性肝衰竭患者却有一定的治疗作用。最近国内也有报道称,重组人促红细胞生成素可通过激活肝脏组织p-eNOSser1177,调节血清中NO与ET-1之间的平衡,发挥对肝脏缺血再灌注损伤的保护作用[18]。Kim SJ[19]等的研究表明未分化的脂肪干细胞具有改善急性肝损伤小鼠的肝功能的能力。在外周循环脂肪干细胞移植中,其能通过内分泌或旁分泌作用,减轻肝脏损害,这也为小肝综合症的治疗提供了一个新的方向。
5 总结
综上所述,小肝综合症是一种以减体积肝移植术后发生的急性肝脏功能障碍为表现的临床综合症。它的发生严重影响患者的生存。随着对其发生机制研究的深入和影像辅助技术及手术技术的发展,其发生率得到逐步降低。在未来,随着干细胞或肝细胞移植等领域研究的突破及对肝细胞再生机制的深入理解,它的防治可能会得到根本解决,并且可能为减体积肝移植技术提供新的突破,这将在很大程度上缓解移植肝源的短缺问题,从而挽救更多患者的生命。
, http://www.100md.com
[参考文献]
[1] Roll GR,Parekh JR,Parker WF, et al. Left hepatectomy versus right hepatectomy for living donor liver transplantation:shifting the risk from the donor to the recipient..Liver Transplantation,2013,19(5):472-81.
[2] Heaton N.Small—for-size liver syndrome after auxiliary and split liver transplantation:donor selection.Liver Transpl,2003,9(9):S26-S28.
[3] 黄洁夫.我国活体肝移植的若干问题[J].中华医学杂志,2009(22):1513-1516.
, http://www.100md.com
[4] 王伟林. 活体肝移植术后小肝综合症的预防与治疗.肝胆外科杂志,2014,22(2):152-153.
[5] Ayuse T, Br ienza N, O. Donnell C P, et al. Pressure-flow analysis of portal vein and hepatic artery interactions in porcine liver[J].Am J Physiol,1994,267(4):1233-1242.
[6] Bo lognes iM, Sacerdo ti D, Bom bonato G, et a.l Change in portal flow a fter liver transplantation: effect on hepatic arterial resistance ind ices and role of spleen size[J].H epato logy,2002(35): 601-608.
, http://www.100md.com
[7] H ende rson JM, G ilm oreG T, M ackayG J, et al. Hemodynamics during liver transp lantation: the interactions between card iac output and portal venous and hepatic arterial flows[J].H epato logy,1992(16):715-718.
[8] 任志刚,周琳,郑树森.小肝综合征(SFSS)的研究进展[J].中华肝胆外科杂志,2011,17(5):437-439
[9] Ito T, K iuch iT, Yamamo toH, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation pathogenesis and clinica limplications [J].Transplanta tion,2003,75(8):1313-1317.
, http://www.100md.com
[10] Kwan Man,Chung-Mau Lo, Irene Oi-Lin Ng,et al. Liver transplantation in rats using small-for-size grafts: a study of hemodynamic and morphological changes[J].A rch Surg, 2001,136(3): 280- 285.
[11] 潘光栋,严律南.成人活体右半肝移植和小肝综合征[J].国际外科学杂志,2006,33(4):256-259.
[12] Debonera F,wallg GD,xie JF,et al.severe preservation injury induces IL-6/STAT3 activation with 1ack of cell cycle progression after partial liver graft transplantation.Am J Transplant,2004,4(12);1964-1971., 百拇医药(尹德成 彭强)
5 总结
综上所述,小肝综合症是一种以减体积肝移植术后发生的急性肝脏功能障碍为表现的临床综合症。它的发生严重影响患者的生存。随着对其发生机制研究的深入和影像辅助技术及手术技术的发展,其发生率得到逐步降低。在未来,随着干细胞或肝细胞移植等领域研究的突破及对肝细胞再生机制的深入理解,它的防治可能会得到根本解决,并且可能为减体积肝移植技术提供新的突破,这将在很大程度上缓解移植肝源的短缺问题,从而挽救更多患者的生命。
, http://www.100md.com
[参考文献]
[1] Roll GR,Parekh JR,Parker WF, et al. Left hepatectomy versus right hepatectomy for living donor liver transplantation:shifting the risk from the donor to the recipient..Liver Transplantation,2013,19(5):472-81.
[2] Heaton N.Small—for-size liver syndrome after auxiliary and split liver transplantation:donor selection.Liver Transpl,2003,9(9):S26-S28.
[3] 黄洁夫.我国活体肝移植的若干问题[J].中华医学杂志,2009(22):1513-1516.
, http://www.100md.com
[4] 王伟林. 活体肝移植术后小肝综合症的预防与治疗.肝胆外科杂志,2014,22(2):152-153.
[5] Ayuse T, Br ienza N, O. Donnell C P, et al. Pressure-flow analysis of portal vein and hepatic artery interactions in porcine liver[J].Am J Physiol,1994,267(4):1233-1242.
[6] Bo lognes iM, Sacerdo ti D, Bom bonato G, et a.l Change in portal flow a fter liver transplantation: effect on hepatic arterial resistance ind ices and role of spleen size[J].H epato logy,2002(35): 601-608.
, http://www.100md.com
[7] H ende rson JM, G ilm oreG T, M ackayG J, et al. Hemodynamics during liver transp lantation: the interactions between card iac output and portal venous and hepatic arterial flows[J].H epato logy,1992(16):715-718.
[8] 任志刚,周琳,郑树森.小肝综合征(SFSS)的研究进展[J].中华肝胆外科杂志,2011,17(5):437-439
[9] Ito T, K iuch iT, Yamamo toH, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation pathogenesis and clinica limplications [J].Transplanta tion,2003,75(8):1313-1317.
, http://www.100md.com
[10] Kwan Man,Chung-Mau Lo, Irene Oi-Lin Ng,et al. Liver transplantation in rats using small-for-size grafts: a study of hemodynamic and morphological changes[J].A rch Surg, 2001,136(3): 280- 285.
[11] 潘光栋,严律南.成人活体右半肝移植和小肝综合征[J].国际外科学杂志,2006,33(4):256-259.
[12] Debonera F,wallg GD,xie JF,et al.severe preservation injury induces IL-6/STAT3 activation with 1ack of cell cycle progression after partial liver graft transplantation.Am J Transplant,2004,4(12);1964-1971., 百拇医药(尹德成 彭强)