肝移植治疗妊娠期合并急性肝衰竭2例并文献复习
Treatment of liver transplantation on acute liver failure of pregnancy: a report of two cases and literature review
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摘要:目的 探讨肝移植治疗妊娠期合并急性肝衰竭的疗效。方法 回顾性分析2004年3月至2015年6月在中山大学附属第三医院接受肝移植的2例妊娠期合并急性肝衰竭患者的临床资料。结果 例1患者因妊娠自然分娩后慢性乙型病毒性肝炎(乙肝)迅速发展而致亚急性肝衰竭, 急诊行肝移植术。例2患者急性肝衰竭病因不明, 因宫内胎儿已是死胎, 在急诊行肝移植后第2日, 由产科医师继续行子宫次全切除术。两例患者术后早期免疫抑制方案均为他克莫司(FK506)+肾上腺皮质激素(激素)。例1患者术后加强抗乙型肝炎病毒治疗, 抗病毒方案为恩替卡韦联合乙肝免疫球蛋白。因例1患者术后仍有继续妊娠的意愿, 在移植物功能稳定后, 使用单一最小剂量免疫抑制剂。例2患者已无妊娠能力, 按常规进行移植术后处理。随访至投稿日, 2例患者恢复良好, 例1未见乙肝复发并且已再次成功分娩1名男婴。结论 妊娠期急性肝衰竭患者行肝移植治疗可获得良好疗效。Abstract:Objective To investigate the curative effect of liver transplantation on acute liver failure of pregnancy.Methods Clinical data of 2 patients with acute liver failure of pregnancy undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from March 2004 to June 2015 were retrospectively studied.Results The patient of case 1 developed subacute liver failure and underwent emergency liver transplantation, because chronic viral hepatitis B (HBV) progressed quickly after natural delivery. The patient of case 2 developed acute liver failure with unknown etiology, and underwent subtotal hysterectomy by the obstetrician on the following day of emergency liver transplantation because the intrauterine fetus was dead. The two patients were given tacrolimus (FK506) and adrenocortical hormone as the postoperative early immunosuppressive regimen. Anti-HBV treatment was enhanced for the patient of case 1 with the antivirus regimen of entecavir combined with hepatitis B immune globulin. The patient of case 1 was willing to continue pregnancy, so the minimal dose of a single immunosuppressant was used when the graft function was stable. The patient of case 2 had no ability of pregnancy and underwent routine postoperative management. The two patients were followed up till the date of submission and they recovered well. The patient of case 1 had no recurrence of HBV and delivered a baby boy successfully.Conclusions Liver transplantation on acute liver failure of pregnancy may obtain good curative effect.
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