Objective To summarize the available clinical research evidence for the treatment of hepatorenal syndrome (HRS). Methods Using the basic methods and principles of evidence-based medicine, we searched and evaluated clinical studies involving the treatment of HRS. Results We found that plasma expansion, vasoconstrictor, transjugular intrahepatic portosystemic shunts (TIPS) and liver transplantation were effective interventions for patients with HRS. Conclusion HRS is a common complication of end-stage liver diseases and the prognosis for patients with HRS is extremely poor. However, due to the small number of clinical trials, small sample sizes and low methodological quality, the strength of the current evidence is limited. Rigorously-designed, randomized, multi-center, large-scale trials on HRS are required.
目的 探讨肝硬化腹水患者不同血清钠水平与病情严重程度的关系。 方法 回顾分析2008年7月－2010年6月收治47例肝硬化腹水并发低钠血症患者，根据其入院时血清钠水平分为低钠血症轻（A组）、中（B组）、重（C组）3组。比较肝硬化腹水患者不同血钠水平的腹水程度及疗效的关系、以及低钠程度与肝性脑病、肝肾综合征和死亡发生率的关系。 结果 与A组比较，B、C两组腹水量、肝性脑病、肝肾综合征及病死率明显增高，差异有统计学意义（P＜0.05）；对治疗的效果明显降低（P＜0.05）。 结论 肝硬化腹水患者的血清钠水平与其病情程度具有紧密相关性，监测血清钠的水平可作为判断病情严重程度的重要指标之一，提示在临床上需重视预防、及时发现并治疗低钠血症。
ObjectiveTo investigate the decision of combined liver and kidney transplantation (CLKT) after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT. MethodsThe data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures. ResultsThree patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, and one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT. ConclusionsThe surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients' long-term survival.