肝移植术围手术期脾亢处理.docVIP

肝移植术围手术期脾亢处理 　 作者：蒋安，吕毅，刘昌，李宗芳，李泉源，史源，马锋 【关键词】 肝移植；脾功能亢进；移植物排斥；血小板；肺部感染 　　Treatment of hypersplenism in perioperation of liver transplantation 　　【Abstract】AIM: To observe the changes in hypersplenism after orthotopic liver transplantation(OLT)and to investigate the influence of splenectomy or splenic artery ligation before or during liver transplantation on the therapeutic outcome. METHODS: Splenectomy or splenic artery ligation was performed on 15(group A) of the consecutive 115 patients undergoing OLT in 5 years, before OTC in 11 of them and during OTC in 4 of them. Sixtyeight randomly selected agematched patients undergoing OTC within the same period but without splenectomy or splenic artery ligation were used as controls (group B). Acute rejection rate , blood PLT count, incidence of lung infection and PVF/HAF（portal venous flow/ hepatic arterial flow） were calculated and analyzed. RESULTS: Lung infaction rate of group A was 85%, significantly higher than that of group B (54%, Plt;0.05); acute rejection did not occur in group A, but in 10 cases of group B(15%), however, without significant differences between them; blood PLT peak level of group A was (340±158)×109/L, significantly higher than that of group B［(249±93)×109/L, Plt;0.01］; blood PLT count reached the peak level 25 d after the operation in group A, and 21 d in group B; no significant difference between them; PVF/PAF was 12±8 in group A，significantly lower than group B(24±16, Plt;0.05). CONCLUSION: Splenectomy should be performed cautiously for hypersplenism based on the operative indications. Spleen artery ligation or embolization is beneficial to the prognosis of the patients with severe thrombocytopenia, arterial steal syndrome or excessive portal vein infusion. 　　【Keywords】liver transplantation; hypersplenism; graft rejection; blood platelets; pulmonary infection 　　【摘要】 目的： 观察原位肝移植术后脾功能亢进(脾亢) 的变化，探讨脾亢患者肝移植的处理方法. 方法： 回顾分析5年内我院115例接受肝移植手术、符合入选条件的脾脏切除或脾动脉结扎患者,将15例作为实验组(A组)，其中11例在术前、4例在术中行脾脏切除术或脾动脉结扎术；