五、细菌性胆管炎
由胆管闭锁和原发性硬化胆管炎引起的肝硬化病人，容易发生细菌性胆管炎。发生细菌性胆管炎时，需要有强有力的抗生素治疗，同时，可以行肝脏穿刺胆管引流。但是，由于肝内脓肿的存在，也有一些病人经上述治疗后感染仍不能完全控制。在没有肝外感染的情况下，这类病人也可以行肝移植手术。感染灶的切除有利于改善病人的情况，术后只要给予合适的广谱抗生素治疗，并不会引起严重的术后感染。
六、肝性脑病
肝性脑病是肝硬化的常见并发症。早期表现为清醒-睡眠规律的颠倒或嗜睡、对周围环境的反应迟钝、抑郁和书写变化。肝性脑病可分为四期（表4-1)。
表4-1 肝性脑病的分期
| 分期 | 临床表现 |
| Ⅰ | 焦虑、易怒、计算能力受损 |
| Ⅱ | 性格改变、记忆力障碍、嗜睡 |
| Ⅲ | 谵妄、昏睡 |
| Ⅳ | 昏迷 |
细菌性腹膜炎、胃肠道出血、大量利尿和穿刺放腹水、电解质紊乱等均可诱发肝性脑病。肝性脑病的治疗主要包括去除诱发因素、抑制肠道菌群、减少食物中蛋白质含量以及足够的能量支持。如果肝性脑病处于Ⅲ、Ⅳ期时，应行紧急肝移植术。肝移植术后肝性脑病可以纠正。
七、肝肾综合征
肝肾综合征（hepatorenal syndrome,HRS)是肝硬化病人肾功能不全的主要原因。消化道出血、大量利尿和穿刺腹水都可以引起肝肾综合征。少尿是肝肾综合征的标志，同时伴有尿素和肌酐的升高。肝肾综合征唯一的治疗就是肝移植。
参考文献
1.Polson RJ,O’Grady JG,Williams R.Liver transplantation in treatment ofhepatic malignancy.Baillieres Clin Gastroenterol ,1987,1:171
2.Ringe B,Wittekind C,Bechstein WO et al.The role of livertransplantation in hepatobiliary malignancy.Aretrospective analysis of 95patients wigh particular regard to tumor stage and recurrence.AnnSurg,1989,209:888
3.Ismil T,Angrisani L,Gunson BK et al.Primary hepatic malignancy:the roleof liver transplantation,Br J Surg,1990,77:983
4.Johansen K,Paun M.Duplex ultrasonography of the portal vein.Surg clinAm,1990,70:181
5.Kaplpokas M,Hackerstedt K,Meknen Jet al.Cardiac evaluation of livertransplantation,Anaesth Intensive Care,1989,17:24
6.TaugrenM,Hackerstedt K,Meknen J et al.Cardiac evaluation of liver transplantrecipients:QT dispersion in electrocardiogram.Clin transplant,1996,105:408
7.Hourani JM,Bellamy PE,Tashkin DP et al.Pulmonary dysfunction inadvanced liver disease:frequent occurrence of an abnormal diffusing capacity,AmJ Med,1991,90:693
8.O’Brien JD,Etting NA.Pulmonary complications of livertransplantation.Clin Chest Med,1996,17:99
9.McCauley J,Van Thiel DH,Starel TE et al .Acute and chronic renalfailure in liver transplantation ,Nephron,1990,55:121
10.Tzakis AG,cooper MH,Dummer JS et al.Transplantation in HIV+patients.Transplantation,1990,49:354
11.Dummer JS,Erb S,Breining MK et al .Infection with humanimmunodeficiency virus in Pittsburgh transplant population,A study of 538 donorand 1043 recipients,1981-1986.Transplantation,1989,47:134
12.Abou JMM,Grant DR,Ghent CN et al.Effect of portosytemic shunts onsubsequent transplantation of liver.Surg Gynecol Obstet,1991,172:215
13.Larson A,Cohen H,Zweiban Bet al.Acute esophageal varicealsclerotherapy:result of a prospective,randomized controlledtrial.JAMA,1986,255:497
14.Sarin SK,Sachdev G,Nanda R et al .Comparison of two time schedules forendoscopic sclerotherapy:a prospective,randomized controlledstudy.Gut,1986,27:710
15.Hou MC,Lin HC,Chcn CH et al.Comparison of endoscopies varicealinjection sclerotherapy and ligation for the treatment of esophageal varicealhemorrhage:a prospective randomized trial.Hepatology,1995,21:1517
16.Imperiale TF,Teran JC,McCullough AJ.Ameta-analysis of somatostatinversus vasopressin in the management of acute esophageal varicealhemorrhage.Gastroenterology,1995,109:1289
17.Abouljioud MS,Levy MF,Rees CR et al .Acomparison of treatment withtransjugular intrahepatic portosystemic shunt of distal splenorenal shunt in themanagement of variceal bleeding prior to livertransplantation.Transplantation,1995 ,59:226
18.Wilson MW,Gordon RL,Laberge JM et al.Liver transplantation complicatedby malpositional transjugular intrahepatic portosystemic shunts,J Vasc IntervRadiol,1995,6:695
19.Papazian A,Braillon ,Dupas JL et al.Portal hypertensive gastricmucosa;an ednoscopic study.Gut,1986,27:1199
20.Gines P,Tito L,Arroyo V et al .Randomized comparative study oftherapeutic paracentesis with and without albumin incirrhosis.Gastroenterology,1988,94:1493
21.Bac DJ.Spontaneous bacterial peritonitis:an indication for livertransplantation?Scand J Gastroenterol ,1996,218(Suppl):38
22.Hoefs JC,Runyen BA.Spontaneous bacterial peritonitis.Dis Mon,1984,31
23.Graer H.Therapy of spontaneous bacterial peritonitis.Schweiz RundschMed Prax,1997,86:98
24.Boyer TD,Kahn An,Reynolds TB.diagnostic value of ascetic fluid lacticdehydrogenase,protein and WBClevels.Arch Int Med,1978,138:1103
25.Cairo JP,Aresias ME,Monteiro E et al.Liver cirrhosis.Clinicalexperience with 274 unselected cases.Digestion,1971,4:223
26.Boixede K,De Luis DA,Aller R et al .Spontaneous bacterialperitonitis.Clinical and microbiological study of 233 episodes.J ClinGastroenterol,1996,23:275
27.Ho H,Zuckerman MJ,Ho TK et al .Prevalence of associated infections incommunity-acquired spontaneous bacterial peritonitis .Am JGastroenterol,1996,91:735
28.Hoefs JC,Runyon BA.Spontaneous bacterial peritonitis .DisMon,1984,1:31
29.Targan SR,Chow AW,Guze LB.Role of anaerobic bacteria in spontaneousperitonitis of cirrhosis.Report of two cases and review of the literature .Am JMed,1977,62:397
30.Rimola A,Salmeron JM,Clementer G et al.Two different dosages ofcefotaxime in the treatment of spontaneous bacterial peritonitis incirrhosis:results of prospective randomized multicenter study.Hepatology,1995,21:674
31.Novella M,Sol R,Soriano G et al.G et al .Continuous versus inpatientprophylaxis of the first episode of spontaneous bacterial peritonitis withnorfloxacin.Hepatology,1997,25:532
32 Van Thiel DH ,Hassanian T,Gurakar Aet al .Liver transplantation afteran acute episode of spontaneous bacterial peritonitis Hepatogastro-enterology,1996,43:1584
