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| 1 | 肝移植术后新发恶性肿瘤的发生和防治(附九例报告)显示文摘目的:探讨肝移植术后新发恶性肿瘤的危险因素和防治措施。方法回顾性研究2003年10月至2008年12月在中山大学附属第三医院肝移植中心行肝移植且接受完整随访的416例中9例新发恶性肿瘤患者临床资料。其中男7例,女2例;年龄30~60岁,中位年龄57岁。术前有吸烟史4例、长期二手烟接触史3例,1例有肝细胞癌(肝癌)家族史。所有患者均签署知情同意书,符合医学伦理学规定。肝移植手术方式均为同种异体改良背驮式肝移植术,采用甲泼尼龙+他克莫司(FK506)或环孢素(CsA)免疫抑制方案。患者术后接受随访,观察新发恶性肿瘤的发生、治疗、预后等情况。结果肝移植术后新发恶性肿瘤发生率为2.2%(9/416),其中消化系统恶性肿瘤3例、呼吸系统恶性肿瘤3例、血液系统恶性肿瘤2例、软组织肉瘤1例。肝移植至肿瘤确诊的时间为10~73个月,中位时间49个月。患者接受相应的手术治疗、放射治疗(放疗)、化学药物治疗(化疗)。5例术后免疫抑制剂转换为西罗莫司,4例FK506用量为肿瘤确诊前的半量。随访期间6例死亡,均死于肿瘤进展和多器官功能衰竭。确诊距死亡的时间为2~25个月,中位时间9个月。结论吸烟和免疫抑制剂的应用可能为肝移植术后新发恶性肿瘤发生的高危因素,进行规范化随访并针对高危因素早期防治是提高疗效的关键。 | 易述红 易慧敏 傅斌生 牛斌 孟炜 李华 许赤 杨扬 陈规划 | 2014 | 中华肝脏外科手术学电子杂志2014，3，3： | 13 |
| 2 | Incidence, risk factors and outcomes of de novo malignancies post liver transplantation显示文摘Liver transplantation(LT) is associated with a 2 to7 fold higher, age and gender adjusted, risk of de novo malignancy. The overall incidence of de novo malignancy post LT ranges from 2.2% to 26%, and 5 and 10 years incidence rates are estimated at 10% to 14.6% and 20% to 32%, respectively. The main risk factors for de novo malignancy include immunosuppression with impaired immunosurveillance, and a number of patient factors which include; age, latent oncogenic viral infections, tobacco and alcohol use history, and underlying liver disease. The most common cancers after LT are non-melanoma skin cancers, accounting for approximately 37% of de novo malignancies, with a noted increase in the ratio of squamous to basal cell cancers. While these types of skin cancer do not impact patient survival, post-transplant lymphoproliferative disorders and solid organ cancer, accounting for 25% and 48% of malignancies, are associated with increased mortality. Patients developing these types of cancer are diagnosed at more advanced stages, and their cancers behave more aggressively compared with the general population. Patients undergoing LT for primary sclerosing cholangitis(particularly with inflammatory bowel disease) and alcoholic liver disease have high rates of malignancies compared with patients undergoing LT for other indications. These populations are at particular risk for gastrointestinal and aerodigestive cancers respectively. Counseling smoking cessation, skin protection from sun exposure and routine clinical follow-up are the current approach in practice. There are no standardized surveillance protocol, but available data suggests that regimented surveillance strategies are needed and capable of yielding cancer diagnosis at earlier stages with better resulting survival. Evidence-based strategies are needed to guide optimal surveillance and safe minimization of immunosuppression. | Pavan Kedar Mukthinuthalapati Raghavender Gotur Marwan GhabrilMarwan Ghabril | 2016 | World Journal of Hepatology2016，8，12： | 7 |
| 3 | Long-term survival after liver transplantation for alcoholic liver disease显示文摘Currently,alcoholic cirrhosis is the second leading indication for liver transplantation in the United States and Europe.The quality of life and survival after a liver transplantation(LT)in patients with alcoholic liver disease(ALD)are similar to those in patients with other cirrhosis etiologies.The alcoholic relapse rate after a LT varies from 10%-50%,and these relapse patients are the ones who present a reduced long-term survival,mainly due to cardiovascular diseases and the onset of de novo neoplasms,including lung and upper aerodigestive tract.Nearly 40%of ALD recipients resume smoking and resume it early post-LT.Therefore,our pre-and post-LT follow-up efforts regarding ALD should be focused not only on alcoholic relapse but also on treating and avoiding other modifiable risk factors such as tobacco.The psychiatric and psychosocial pre-LT evaluation and the post-LT follow-up with physicians,psychiatrists and addiction specialists are important for reversing these problems because these professionals help to identify patients at risk for relapse as well as those patients who have relapsed,thus enabling responsive actions. | Paula Iruzubieta Javier Crespo Emilio Fábrega | 2013 | World Journal of Gastroenterology2013，19，48： | 4 |
| 4 | 酒精性肝病与肝移植显示文摘酒精性肝病(ALD)是由于大量饮酒所致的肝脏疾病,包括酒精性脂肪肝、酒精性肝炎(AH)和酒精性肝硬化(ALC)等,ALD是西方国家晚期肝病的最主要原因,也是慢性肝病中行肝移植治疗的第二大适应证。近年来,我国的ALD患者也有明显增加的趋势,ALD在我国肝硬化的病因构成比从1999年的10.8%上升至2003年的24.0%,患病率呈逐年上升趋势,已成为一个不可忽视的问题。ALD的治疗包括戒酒、营养支持、保肝药物治疗以及并发症的治疗等。 | 张天才 郭文治 张水军 | 2015 | 中华器官移植杂志2015，36，3： | 0 |
| 5 | 乙醇性肝病肝移植新进展显示文摘饮酒是人类文明盛传已久的习惯之一,近年随着全球酒的消费量猛增,乙醇性肝炎的发病率也不断攀升。根据世界卫生组织报告,全球范围内有约7630万人被诊断为乙醇滥用引起的肝炎,每年死于乙醇滥用的人数已达到3.2%,有4.0%的人被疾病困扰。 | 俞泽元 李玉民 焦作义 | 2014 | 中国普外基础与临床杂志2014，21，7： | 0 |
| 6 | MSCT影像分型对婴儿肝炎综合征的应用价值显示文摘目的探讨MSCT影像分型对婴儿肝炎综合征(IHS)的临床价值。方法收集IHS患儿78例,行128排MSCT多期增强扫描,对影像征象进行分型并与病理进行比较。结果 IHS的MSCT常见征象包括肝肿胀(45例,57.8%)、肝实质异常强化(74例,94.9%)、门静脉周围水肿(16例,20.5%)、包膜强化(2例,2.6%)。根据影像征象分为4型:肝实质炎症型(37例,47.4%)、胆道梗阻型(23例,29.5%)、淋巴水肿型(16例,20.5%)、包膜炎症型(2例,2.6%)。MSCT对IHS异常征象部位的显示能力高于超声(χ2=26.951,P=0.000)。结论 MSCT影像分型有助于了解IHS肝炎的部位和病理特点。 | 谢强 洪庆山 林焕西 张贵彬 王群 | 2015 | 影像诊断与介入放射学2015，24，5： | 0 |
| 7 | 活体肝移植供受体术前评估的影像学技术显示文摘肝移植是目前治疗终末期肝病最有效的方法。肝移植分为尸体肝移植和活体肝移植两种。与尸体肝移植相比,活体肝移植成功率更高。术前对肝移植供体及受体进行系统的影像学评价是活体肝移植的关键步骤之一。目前,供、受体影像学技术主要包括超声检查、多层螺旋计算机体层摄影术(MSCT)和磁共振成像(MRI)。本文就近年来活体肝移植术前影像学评估方面的研究进展作一阐述。 | 郭佑民 邓蕾 | 2013 | 中华肝脏外科手术学电子杂志2013，2，2： | 0 |
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