• 1.重慶市婦幼保健院產(chǎn)科(重慶400013）;;
  • 2.四川大學(xué)華西醫(yī)院普外二科（成都610041）;

目的 探討肝移植術(shù)后妊娠的指征，母體和胎兒/新生兒存在的風(fēng)險及其處理措施。
方法復(fù)習(xí)相關(guān)文獻并進行綜述。
結(jié)果肝移植術(shù)后多數(shù)育齡婦女可以恢復(fù)正常月經(jīng)周期。高血壓、腎功能損害、先兆子癇、繼發(fā)于免疫抑制的細菌和病毒感染以及剖宮產(chǎn)幾率增加是母體的主要風(fēng)險。胎兒/新生兒的風(fēng)險主要是流產(chǎn)、早產(chǎn)、胎膜早破、腎上腺皮質(zhì)功能不足、胎兒畸形、免疫缺陷和巨細胞病毒、乙肝病毒及細菌感染。
結(jié)論在多數(shù)患者，肝移植術(shù)后妊娠可以獲得良好效果，但在妊娠前應(yīng)進行嚴格的評估，在妊娠期應(yīng)多科聯(lián)合進行嚴密的監(jiān)測。當前應(yīng)制定一個基于現(xiàn)有研究結(jié)果的肝移植術(shù)后妊娠指南。

引用本文： 陳真,文天夫. 肝移植術(shù)后妊娠. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(4): 487-489下轉(zhuǎn)492. doi: 復(fù)制

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5. Sander M, Lyson T, Thomas GD, et al. Sympathetic neural mechanisms of cyclosporineinduced hypertension [J]. Am J Hypertens， 1996; 9(11)∶121S.
6. Armenti VT, Herrine SK, Radomski JS, et al. Pregnancy after liver transplantation [J]. Liver Transpl， 2000; 6(6)∶671.
7. Carr DB, Larson AM, Schmucker BC, et al. Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation [J]. Liver Transpl， 2000; 6(2)∶213.
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10. Pruvot FR, Declerck N, ValatRigot AS, et al. Pregnancy after liver transplantation: focusing on risks to the mother [J]. Transplant Proc， 1997; 29(5)∶2470.
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12. Ratanajamit C, Vinther Skriver M, Jepsen P, et al. Adverse pregnancy outcome in women exposed to acyclovir during pregnancy: a populationbased observational study [J]. Scand J Infect Dis， 2003; 35(4)∶255.
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14. Florman S, Schiano T, Kim L, et al. The incidence and significance of late acute cellular rejection (〖HT7〖JX-*7>HT61 000 days) after liver transplantation [J]. Clin Transplant， 2004; 18(2)∶152.
15. Vennarecci G, Pisani F, Tisone G, et al. Kidney transplantation and pregnancy [J]. Transplant Proc， 1997; 29(7)∶2797.
16. OldakowskaJedynak U, Niewczas M, Ziolkowski J, et al. Cytomegalovirus infection as a common complication following liver transplantation [J]. Transplant Proc， 2003; 35(6)∶2295.
17. Seehofer D, Meisel H, Rayes N, et al. Prospective evaluation of the clinical utility of different methods for the detection of human cytomegalovirus disease after liver transplantation [J]. Am J Transplant， 2004; 4(8)∶1331.
18. Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant [J]. Clin Microbiol Rev， 2002; 15(4)∶680.
19. Fowler KB, Stagno S, Pass RF, et al. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status [J]. N Engl J Med， 1992; 326(10)∶663.
20. Schen FP, Stallone G, Schena A, et al. Pregnancy in renal transplantation: immunologic evaluation of neonates from mothers with transplanted kidney [J]. Transpl Immunol， 2002; 9(2-4)∶161.
21. Laifer SA, Guido RS. Reproductive function and outcome of pregnancy after liver transplantation in women [J]. Mayo Clin Proc， 1995; 70(4)∶388.
22. Tsai MY, Chang SY, Hsiu DY, et al. Pregnancy after orthotopic liver transplantation in a Chinese patient: a case report [J]. Changgeng Yi Xue Za Zhi， 1998; 21(1)∶67.
  1. 1. Mass K, Quint EH, Punch MR, et al. Gynecological and reproductive function after liver transplantation [J]. Transplantation, 1996; 62(4)∶476.
  2. 2. EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section Ⅳ: Longterm management of the transplant recipient. Ⅳ.10. Pregnancy in renal transplant recipients [J]. Nephrol Dial Transplant， 2002; 17 Suppl 4∶1.
  3. 3. Jain A, Venkataramanan R, Fung JJ, et al. Pregnancy after liver transplantation under tacrolimus [J]. Transplantation， 1997; 64(4)∶559.
  4. 4. Braun N, Dette S, Viebahn R. Impairment of renal function following liver transplantation [J]. Transplant Proc， 2003; 35(4)∶1458.
  5. 5. Sander M, Lyson T, Thomas GD, et al. Sympathetic neural mechanisms of cyclosporineinduced hypertension [J]. Am J Hypertens， 1996; 9(11)∶121S.
  6. 6. Armenti VT, Herrine SK, Radomski JS, et al. Pregnancy after liver transplantation [J]. Liver Transpl， 2000; 6(6)∶671.
  7. 7. Carr DB, Larson AM, Schmucker BC, et al. Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation [J]. Liver Transpl， 2000; 6(2)∶213.
  8. 8. Sturgiss SN, Davison JM. Perinatal outcome in renal allograft recipients: prognostic significance of hypertension and renal function before and during pregnancy [J]. Obstet Gynecol， 1991; 78(4)∶573.
  9. 9. Pruvot FR, Noel C. Comment on “Pregnancy after liver transplantation under tacrolimus” by Jain et al [J]. Transplantation， 1998; 65(10)∶1415.
  10. 10. Pruvot FR, Declerck N, ValatRigot AS, et al. Pregnancy after liver transplantation: focusing on risks to the mother [J]. Transplant Proc， 1997; 29(5)∶2470.
  11. 11. Armenti VT, Herrine SK, Moritz MJ. Reproductive function after liver transplantation [J]. Clin Liver Dis， 1997; 1(2)∶471.
  12. 12. Ratanajamit C, Vinther Skriver M, Jepsen P, et al. Adverse pregnancy outcome in women exposed to acyclovir during pregnancy: a populationbased observational study [J]. Scand J Infect Dis， 2003; 35(4)∶255.
  13. 13. Jain AB, Reyes J, Marcos A, et al. Pregnancy after liver transplantation with tacrolimus immunosuppression: a single center’s experience update at 13 years [J]. Transplantation， 2003; 76(5)∶827.
  14. 14. Florman S, Schiano T, Kim L, et al. The incidence and significance of late acute cellular rejection (〖HT7〖JX-*7>HT61 000 days) after liver transplantation [J]. Clin Transplant， 2004; 18(2)∶152.
  15. 15. Vennarecci G, Pisani F, Tisone G, et al. Kidney transplantation and pregnancy [J]. Transplant Proc， 1997; 29(7)∶2797.
  16. 16. OldakowskaJedynak U, Niewczas M, Ziolkowski J, et al. Cytomegalovirus infection as a common complication following liver transplantation [J]. Transplant Proc， 2003; 35(6)∶2295.
  17. 17. Seehofer D, Meisel H, Rayes N, et al. Prospective evaluation of the clinical utility of different methods for the detection of human cytomegalovirus disease after liver transplantation [J]. Am J Transplant， 2004; 4(8)∶1331.
  18. 18. Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant [J]. Clin Microbiol Rev， 2002; 15(4)∶680.
  19. 19. Fowler KB, Stagno S, Pass RF, et al. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status [J]. N Engl J Med， 1992; 326(10)∶663.
  20. 20. Schen FP, Stallone G, Schena A, et al. Pregnancy in renal transplantation: immunologic evaluation of neonates from mothers with transplanted kidney [J]. Transpl Immunol， 2002; 9(2-4)∶161.
  21. 21. Laifer SA, Guido RS. Reproductive function and outcome of pregnancy after liver transplantation in women [J]. Mayo Clin Proc， 1995; 70(4)∶388.
  22. 22. Tsai MY, Chang SY, Hsiu DY, et al. Pregnancy after orthotopic liver transplantation in a Chinese patient: a case report [J]. Changgeng Yi Xue Za Zhi， 1998; 21(1)∶67.