肝豆状核变性(Wilson病)治疗策略的变革及思考

评析肝豆状核变性(WD)当前的治疗方法,主要有低铜饮食,铜的螯合剂青霉胺及曲恩汀,锌制剂和四硫钼酸胺,肝移植.介绍WD治疗策略的变革:不再提倡驱铜疗法以去除堆积的铜,而是使血液中的游离铜离子浓度常态化以逆转铜中毒,并结合2007年《柳叶刀》WD治疗专家共识进行思考.最后,展望未来对WD可能的根治疗法,即基因治疗、肝细胞移植及现在可施行的肝移植.     

脾窝异位辅助性活体肝移植治疗Wilson'S病的多方位思考

肝豆状核变性(Wilson's病)是一种铜代谢异常的遗传性疾病,肝移植是治疗Wilson's病的良好方法.我院器官移植中心于2007年6月至2008年6月期间应用牌窝异位辅助性活体肝脏移植治疗肝豆状核变性4例,在评估治疗效果和总结经验的同时,我们对这一治疗方法进行了几点思考,并对其伦理学争议进行了讨论.脾窝异位辅助性活体肝移植为治疗Wilson'S提供一条有效的、安全的、简单的全新途径.     

脾窝异位辅助性活体肝移植治疗Wilson’s病的多方位思考

肝豆状核变性（wilson’s病）是一种铜代谢异常的遗传性疾病,肝移植是治疗Wilson’s病的良好方法。我院器官移植中心于2007年6月至2008年6月期间应用脾窝异位辅助性活体肝脏移植治疗肝豆状核变性4例,在评估治疗效果和总结经验的同时,我们对这一治疗方法进行了几点思考,并对其伦理学争议进行了讨论。脾窝异位辅助性活体肝移植为治疗Wilson’s提供一条有效的、安全的、简单的全新途径。     

肝衰竭治疗的最新进展

目前肝衰竭的发病率及死亡率居高不下,肝衰竭仍是严重危害患者健康及生命的重要疾病。一直以来,中国肝衰竭的临床治疗主要依靠单纯药物治疗,随着医疗水平的进步,近年来中国非生物型人工肝技术已得到广泛的临床应用,采用肝移植成功治疗肝衰竭的临床案例也逐渐增多。目前国内外肝衰竭治疗的最新进展主要集中在人工肝、肝移植,本文就肝衰竭的营养支持、病因治疗、并发症的治疗、免疫调节、人工肝、肝移植及干细胞移植对肝衰竭治疗的最新进展做一简要综述。     

TIPS在肝移植术后难治性腹水中的应用

两例肝移植术后患者出现难治性腹水,明确病因、改善一般状况及肝肾功能后,给予TIPS治疗.TIPS术后1周,两例患者腹水消失,至今已分别随访15月、37月,均未出现肝性脑病、肝功能异常等并发症.肝移植术后TIPS的主要适应症为难治性腹水、食道静脉曲张出血及流出道梗阻.TIPS是治疗肝移植术后难治性腹水一种安全、有效的方法,具有一定的临床治疗意义.     

可切除早期肝癌行肝移植还是行肝切除

可切除早期肝癌患者治疗（行切除或肝移植）,必须依据事物的主要矛盾及矛盾的主要方面来选择,在实践中不断提高,同时两种治疗方法是统一可以互相转换的,以最终延长肝癌患者生存为目的。     

我国肝癌肝移植的现况与伦理争论

肝移植是目前治疗肝癌最有效的方法。虽然活体肝移植让人们看到了解决肝源短缺的希望,但短时间内肝源短缺依然是困扰肝移植的瓶颈问题,并由此引发肝癌肝移植的伦理争论。虽然肝癌是肝移植适应证之一,但业内人士一致认为对肝癌肝移植应采取谨慎态度并提高其纳入标准。本文就肝癌肝移植相关伦理问题加以探讨。     

我国肝癌肝移植的现况与伦理争论

肝移植是目前治疗肝癌最有效的方法.虽然活体肝移植让人们看到了解决肝源短缺的希望,但短时间内肝源短缺依然是困扰肝移植的瓶颈问题,并由此引发肝癌肝移植的伦理争论.虽然肝癌是肝移植适应证之一,但业内人士一致认为对肝癌肝移植应采取谨慎态度并提高其纳入标准.本文就肝癌肝移植相关伦理问题加以探讨.     

肝癌肝移植与放弃治疗的伦理选择

探讨我国肝癌肝移植现状及其伦理要求.在我国卫生资源短缺且分配不公的形式下,肝移植手术大幅度增长的背后隐藏的是尖锐的伦理冲突.后现代主义哲学与伦理学,尤其是生命价值理论对放弃治疗予以理论支撑.在肝癌肝移植与放弃治疗的伦理冲突中,做出公平审慎的选择.     

亲体肝移植的伦理学问题探讨

目前,肝移植已成为治疗终末期肝病的有效手段。活体肝移植术部分解决了供肝短缺的问题,10多年来其发展迅速,并取得了良好的疗效。由于活体肝移植需从活的供体身上切取部分肝脏,且供体多为患者家属,故存在着供体的选择、供体的贡献与代价,患者的家庭、心理、社会等伦理学问题。因此在提高活体肝移植技术水平的同时,必须充分考虑活体肝移植的伦理学问题,遵守伦理原则,使活体肝移植不但能从技术上达到,在伦理学方面也是可行的。     

A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease

Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.     

侵袭性垂体腺瘤的个性化治疗

近10多年来,不断有新的方法应用于临床治疗食管胃底静脉曲张破裂出血并取得很大进展,如药物的联合应用、经颈内静脉肝内门体分流术、经内镜食管曲张静脉套扎术及硬化剂注射术、冠状静脉栓塞术、肝移植等。对以上治疗方法及其利弊、选择原则等进行了分析。     

漫谈肝移植现状、挑战与前景

就肝移植目前的状况和存在的问题,如医疗机构的组织协调能力,供肝不足和手术过程中的难点,肝癌肝移植争议的焦点,如何提高移植后的生存质量等,提出了建设性有益的观点,为肝移植的未来指出了光明前景。     

The ethical assessment of innovative therapies: Liver transplantation using living donors

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide. Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines for the procedure before it was introduced in the United States. We used a process of “research ethics consultation” that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery.     

肝移植的伦理学问题

肝脏移植和其它器官移植一起实现了人类长期以来渴望生命再生的梦想,并成为终末期肝病的有效治疗方法。器官移植也面对许多伦理道德方面的难题。供体,特别是活体器官的摘取,受体的选择等,都受到社会道德观的制约。从伦理道德角度来分析如何制定相关的法律法规,成为当前社会关注的热点。从受体的利益、人体科研的道德规范以及相关制度的伦理学要求等方面,较为详细的阐述肝移植伦理学的基本原则。     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

肝移植技术应用及其伦理学思考

探讨我国肝移植技术广泛应用的途径,阐述肝移植现状及其面临的伦理道德问题,认为:人们的传统思想文化背景及伦理道德观严重影响了肝移植技术的应用,要加大宣传,改变观念,尽早立法实行科学的脑死亡法。