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Трансплантология

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Трансплантация печени при гепатопульмональном синдроме: обзор литературы и клинический случай

https://doi.org/10.23873/2074-0506-2017-9-1-23-34

Аннотация

Гепатопульмональный синдром – тяжелое осложнение заболевания печени, характеризующееся триадой симптомов: болезнь печени, легочная вазодилатация и артериальная гипоксемия (РаО2 менее 70 мм рт.ст. в покое). Прекапиллярная вазодилатация, ангиогенез в легких и гипердинамический тип кровообращения приводят к артериовенозному шунтированию в легких и ограничению диффузии газов. При выявлении макроскопических артериовенозных шунтов возможна эмболизация ветвей легочной артерии, однако единственным радикальным методом лечения гепатопульмонального синдрома на данный момент является трансплантация печени. Пятилетняя выживаемость пациентов, страдающих гепатопульмональным синдромом после трансплантации, составляет около 70%. Уровень периоперационной летальности сохраняется высоким (8,5–29%), особенно у пациентов с PaO2 менее 50 мм рт.ст. В послеоперационном периоде зачастую требуется пролонгирование искусственной вентиляции легких, возможно применение неинвазивной вентиляции, а в тяжелых случаях показана экстракорпоральная мембранная оксигенация. В данной статье приводятся обзор исследований, посвященных этой проблеме, и описание клинического случая успешной трансплантации печени пациенту, страдающему циррозом печени и гепатопульмональным синдромом с тяжелой гипоксемией (PaO2 менее 50 мм рт.ст.).

Об авторах

Ю. О. Малиновская
ГБУЗ МО МОНИКИ им. М.Ф. Владимирского
Россия

научный сотрудник отделения абдоминальной хирургии  

Москва, Россия



Д. Джинер
ФГБОУ ВО Первый МГМУ им. И.М. Сеченова МЗ РФ
Россия
Москва, Россия


Е. Н. Остроумов
ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия
Москва, Россия


Я. Г. Мойсюк
ГБУЗ МО МОНИКИ им. М.Ф. Владимирского
Россия
Москва, Россия


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Рецензия

Для цитирования:


Малиновская Ю.О., Джинер Д., Остроумов Е.Н., Мойсюк Я.Г. Трансплантация печени при гепатопульмональном синдроме: обзор литературы и клинический случай. Трансплантология. 2017;9(1):23-34. https://doi.org/10.23873/2074-0506-2017-9-1-23-34

For citation:


Malinovskaya Yu.O., Dzhiner D., Ostroumov E.N., Moysyuk Ya.G. Hepatopulmonary syndrome and liver transplantation: the review and a case report. Transplantologiya. The Russian Journal of Transplantation. 2017;9(1):23-34. https://doi.org/10.23873/2074-0506-2017-9-1-23-34

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