Ho Cheng-Maw, Lee Po-Huang, Cheng Wing Tung, Hu Rey-Heng, Wu Yao-Ming, Ho Ming-Chih
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, E-Da Hospital, I-Shou University, Taiwan.
Ann Med Surg (Lond). 2016 Nov 14;12:47-53. doi: 10.1016/j.amsu.2016.11.004. eCollection 2016 Dec.
Literature on liver transplantation for use in medical education is limited and as yet unsatisfactory. The aim of this article is to help medical students gain enough insight into the reality of being a liver transplant recipient. This is crucial so in the future they can feel confident in approaching these patients with adequate knowledge and confidence. The knowledge-tree based learning core topics are designed for a 2-h class including indication/contraindication in the real-world setting, model for end stage liver disease scoring and organ allocation policy, liver transplantation for hepatic malignancy, transplantation surgery, immunosuppression strategy in practical consideration, and management of viral hepatitis. The rationales of each topic are discussed comprehensively for better understanding by medical students. Recipient candidates may have reversible contraindications that halt the surgery temporarily and therefore, it warrants re-evaluation before transplant. Organ allocation policy is primarily based on disease severity instead of waiting time. Transplant surgery usually involves resection of the whole liver, in situ implantation with reconstruction of the hepatic vein, the portal vein, the hepatic artery and the biliary duct in sequence. The primary goal of artificial immunosuppression is to prevent graft rejection, and the secondary one is to reduce its complication or side effects. Life-long oral nucleoside/nucleotide analogues against hepatitis virus B is needed while short course of direct acting agents against hepatitis viral C is enough to eradicate the virus. Basic understanding of the underlying rationales will help students prepare for advanced learning and cope with the recipients confidently in the future.
用于医学教育的肝移植相关文献有限，且目前并不令人满意。本文的目的是帮助医学生对肝移植受者的实际情况有足够的了解。这至关重要，以便他们未来能够有足够的知识和信心去接触这些患者。基于知识树的学习核心主题设计为一个2小时的课程，内容包括现实环境中的适应证/禁忌证、终末期肝病评分模型和器官分配政策、肝恶性肿瘤的肝移植、移植手术、实际考虑中的免疫抑制策略以及病毒性肝炎的管理。每个主题的基本原理都进行了全面讨论，以便医学生更好地理解。肝移植候选者可能有可逆的禁忌证，这会暂时中止手术，因此在移植前需要重新评估。器官分配政策主要基于疾病严重程度而非等待时间。移植手术通常包括切除整个肝脏，依次进行原位植入并重建肝静脉、门静脉、肝动脉和胆管。人工免疫抑制的主要目标是防止移植物排斥，次要目标是减少其并发症或副作用。对于乙肝病毒需要终身口服核苷/核苷酸类似物，而针对丙肝病毒的直接作用药物短期疗程就足以根除病毒。对基本原理的理解将有助于学生为进一步学习做好准备，并在未来自信地应对肝移植受者。
