ALIMENT PHARM THERAP:肝移植对门脉高压引起的肺疾病有效

2012-12-06 刘沛编译 ALIMENT PHARM THERAP

　　近日，《营养药理学与治疗学（Alimentary Pharmacology & Therapeutics）》杂志的一篇论文指出，肝移植是肝肺综合征和门脉肺动脉高压患者的有效治疗措施。但有效的筛查、早期诊断、术前改善生理指标和精细的术后护理将确保病人有良好的转归。[Aliment Pharmacol Ther 2012:&nbs

　　近日，《营养药理学与治疗学（Alimentary Pharmacology & Therapeutics）》杂志的一篇论文指出，肝移植是肝肺综合征和门脉肺动脉高压患者的有效治疗措施。但有效的筛查、早期诊断、术前改善生理指标和精细的术后护理将确保病人有良好的转归。[Aliment Pharmacol Ther 2012: DOI: 10.1111/apt.12140]

　　肝移植对伴有门脉肺动脉高压和肝肺综合征的患者可能是一种挽救生命的治疗措施。但由于资料所限，还未能确定病人能否接受此手术的相关标准。事实上，有人认为对于中度至重度的门脉肺动脉高压和重度肝肺综合征患者，移植并不是合适的选择。

　　英国的Houlihan医生的研究小组评价了肝移植在肝肺综合征和门脉肺动脉高压治疗中的应用。研究小组于2012年检索了PubMed、Ovid Embase、Ovid Medline和Scopus数据库中包含“肝肺综合征”、“门脉肺动脉高压”、“肺动脉高压”、“肝移植”的关键词。相关的文章被纳入综述中。

　　研究者报告了肝移植已经成为特定的一些伴有肝肺综合征和门脉肺动脉高压病人的有效治疗方式。一个多学科小组的合作治疗方案旨在改善肝肺综合征患者的氧合，病人的转归有明显改善。

　　此外，研究小组指出仔细确定病人的入选标准以及肺血管靶向治疗将有助于治疗门脉肺动脉高压，并提高肝移植的成功率。

Review article: liver transplantation for the pulmonary disorders of portal hypertension

Background

Liver transplantation is potentially a life-saving therapeutic intervention for patients with portopulmonary hypertension and hepatopulmonary syndrome. However, due to limited data, listing criteria for patients with these conditions have not been clearly established. Indeed, this has led some to speculate that transplantation may not be appropriate in cases of moderate-to-severe portopulmonary hypertension and severe hepatopulmonary syndrome.

Aim

To critically discuss the utility of LT for the treatment of hepatopulmonary syndrome and portopulmonary hypertension.

Methods

A literature search was conducted in 2012 on PubMed, Ovid Embase, Ovid Medline and Scopus using the following search terms: hepatopulmonary syndrome, portopulmonary hypertension, pulmonary arterial hypertension, liver transplantation. Relevant manuscripts were included in the review.

Results

Liver transplantation has established itself as an effective treatment for selected patients with hepatopulmonary syndrome and portopulmonary hypertension. A multidisciplinary team approach incorporating focused strategies (both pre- and post-operatively) aimed at improving oxygenation in patients with hepatopulmonary syndrome has led to a dramatic improvement in patient outcomes. Additionally, careful patient selection and the use of targeted pulmonary vascular therapies are successfully being used to treat portopulmonary hypertension and ‘bridge’ patients to successful liver transplantation.

Conclusions

Liver transplantation is an effective therapy for patients with hepatopulmonary syndrome and portopulmonary hypertension. However, rigorous screening and early identification of these conditions allied with aggressive pre-operative optimisation of physiology and diligent post-operative care are imperative to ensuring a good outcome.

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2013-08-08 jj000001

#Pharm#

73 0
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2013-09-19 124988c7m106暂无昵称

#ERA#

49 0
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2012-12-08 zhaojie88

#门脉高压#

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