劈离式肝移植术后成功妊娠分娩1例并文献复习  

Successful pregnancy and delivery after split liver transplantation:A case report and literature review

作　　者：赵柳 徐琳[3] 刘虹[1,2] 郭源[1,2] 李志强[1,2] 蔡金贞 臧运金[1,2] 饶伟[1,2] ZHAO Liu;XU Lin;LIU Hong;GUO Yuan;LI Zhiqiang;CAI Jinzhen;ZANG Yunjin;RAO Wei(Division of Hepatholgy Liver Disease Center,Department of Organ Transplantation Center,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院器官移植中心,肝脏病中心,山东青岛266100 [2]青岛大学移植医学研究所 [3]青岛大学附属医院产科

出　　处：《精准医学杂志》2024年第1期67-70,共4页Journal of Precision Medicine

摘　　要：目的探讨劈离式肝移植(SLT)术后患者妊娠分娩的临床管理经验。方法收集1例我院器官移植中心收治的SLT术后妊娠并成功分娩患者的临床资料,并复习相关文献。结果患者因“自身免疫性肝炎后肝硬化(失代偿期)”接受同种异体原位SLT,术后出现轻度急性排斥反应,经调整免疫抑制药物治疗后好转。患者术后2年自然妊娠,因既往服用麦考酚钠肠溶片,选择终止妊娠并停用该药。术后3年再次妊娠并出现移植物波动,予调整抗排异药物剂量、保肝对症治疗、先兆早产保胎治疗等处理,最终在肝移植科、产科和新生儿科等相关学科共同指导下,于孕35周剖宫产诞下1名健康女婴。结论SLT受者虽然孕期可能出现移植物功能波动、早产等情况,但在多学科共同合作、科学指导用药及密切随访监测下,亦可以获得满意预后。Objective To investigate the experience in the clinical management of pregnancy and delivery after split liver transplantation(SLT).Methods Related clinical data were collected from a patient who became pregnant and delivered successfully after SLT in the Organ Transplantation Center of our hospital,and a literature review was also performed.Results The patient underwent allogeneic orthotopic SLT due to decompensated liver cirrhosis after autoimmune hepatitis and developed mild acute rejection after surgery,which was improved after the adjustment of immunosuppressive drugs.The patient became pregnant spontaneously at 2 years after surgery,and due to the medication history of mycophenolate sodium enteric-coated tablets,she decided to terminate pregnancy and withdraw from this drug.The patient became pregnant again at 3 years after surgery and expe-rienced fluctuations in graft function,and a series of treatments were given,such as adjustment of the dose of anti-rejection drugs,liver-protecting symptomatic treatment,and tocolytic therapy for threatened preterm labor.Finally under the guidance of liver transplantation,obstetrics,and neonatology,the patient gave birth to a healthy girl by cesarean section at 35 weeks of gestation.Conclusion Although SLT recipients may experience the situations such as fluctuations in graft function and preterm birth,they can achieve a satisfactory prognosis under multidisciplinary collaboration,scientific medication guidance,and close follow-up monitoring.

关 键 词：肝移植 预后 妊娠 免疫抑制剂 移植物排斥 肝功能不全 

分 类 号：R657.3[医药卫生—外科学] R617[医药卫生—临床医学] R714