肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效分析

doi:10.3969/j.issn.2095-5332.2020.06.011

实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (6): 461-465.DOI: 10.3969/j.issn.2095-5332.2020.06.011

肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效分析

田大治，贺健，李江，张骊，张炜琪，蒋文涛

天津市第一中心医院肝移植科，天津市器官移植临床医学研究中心，中国医学科学院移植医学重点实验室，天津市器官移植重点实验室，天津 300192

出版日期:2020-11-20 发布日期:2021-06-01

Curative effect analysis of preventive splenic artery ligation during liver transplantation in patients at high risk forsplenic artery steal syndrome

Tian Dazhi，He Jian，Li Jiang，Zhang Li，Zhang Weiqi，Jiang Wentao.

Liver Transplantation Department，Tianjin First CenterHospital，Key Laboratory for Critical Care Medicine of the Ministry of Health，Tianjin Key Laboratory for Organ Transplantation，Tianjin Clinical Research Center for Organ Transplantation，Key Laboratory of Transplant Medicine，Chinese Academy of MedicalSciences，Tianjin 300192

Online:2020-11-20 Published:2021-06-01

摘要/Abstract

摘要：

目的探讨肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效及其安全性。方法纳入脾动脉窃血高危患者 68 例（存在以下任一点即可：① 脾动脉直径＞ 5 mm ；② 脾动脉直径 / 肝固有动脉直径＞ 1.5 ；③ 脾体积＞ 829 ml），根据肝移植术中是否结扎脾动脉分为结扎组（22 例）和非结扎组（46 例），比较两组围术期相关临床资料。结果两组相比，结扎组受者术后无一例发生脾动脉窃血，明显低于非结扎组（21.74%），差异具有统计学意义（χ2 ＝ 4.008，P ＜ 0.05）。术后结扎组受者的脾动脉直径、脾动脉直径 / 肝固有动脉直径、脾体积明显低于非结扎组，差异有统计学意义（P ＜ 0.05）。术后结扎组的肝动脉流速（47.53±2.17）cm/s 明显高于非结扎组（31.10±1.14）cm/s，差异有统计学意义（t ＝ 7.384，P ＜ 0.001）；两组术前术后的门静脉流速均无统计学差异。肝移植术后 1、2、3 周时，结扎组的丙氨酸转移酶、总胆红素水平明显低于非结扎组，差异有统计学意义（P ＜ 0.05）。结论对于脾动脉窃血高危受者，肝移植术中预防性结扎脾动脉是安全有效的。

关键词:

肝移植 , 脾动脉结扎 , 脾动脉窃血

Abstract:

Objective To investigate the efficacy and safety of preventive splenic artery ligation during liver transplantation in patients at high risk for splenic artery steal syndrome. Methods Sixty eight patients withhigh risk of spleen artery stealing（meet any points of the following is eligible，① The diameter of the spleen artery ＞ 5 mm ；② The diameter of the spleen artery / the diameter of the proper hepatic artery ＞ 1.5 ；③ The spleen volume ＞ 829 ml）were included. According to whether the splenic artery was ligated during liver transplantation，patients were divided into ligated group（22 cases）and non-ligated group（46 cases）.The clinical data of perioperative period were compared between the two groups. Results Compared with the two groups，none of the recipients inthe ligation group had splenic artery stealing after surgery，which was significantly lower than that in the non-ligated

group （21.74%），and the difference was statistically significant （χ2 ＝ 4.008，

P ＜ 0.05）。 The postoperative splenicspleen artery diameter，splenic artery diameter / proper hepatic artery diameter，and spleen volume of therecipients in the ligation group were significantly lower than those in the non-ligated group，and the differences were statistically significant（P ＜ 0.05）. The postoperative hepatic arterial flow velocity（47.53±2.17）cm/s in the ligation group was significantly higher than that in the non-ligated group（31.10±1.14）cm/s，and the difference was statistically significant（t ＝ 7.384，P ＜ 0.001）. There was no statistical difference in portal flow velocity before and after surgery between two groups. At 1 week，2 weeks and 3 weeks after liver transplantation，the levels of alanineaminotransferase and total bilirubin in the ligated group were significantly lower than those in the non-ligated group，and the differences were statistically significant（P ＜ 0.05）. Conclusion For patients at high risk of splenic artery steal syndrome，prophylactic ligation of the splenic artery during liver transplantation is safe and effective.

Key words:

Liver transplantation, Splenic artery ligation, Splenic artery steal syndrome

田大治, 贺健, 李江, 张骊, 张炜琪, 蒋文涛.

肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效分析

[J/CD]. 实用器官移植电子杂志, 2020, 8(6): 461-465.

Tian Dazhi, He Jian, Li Jiang, Zhang Li, Zhang Weiqi, Jiang Wentao..

Curative effect analysis of preventive splenic artery ligation during liver transplantation in patients at high risk forsplenic artery steal syndrome

[J]. Practical Journal of Organ Transplantation(Electronic Version), 2020, 8(6): 461-465.

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肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效分析

Curative effect analysis of preventive splenic artery ligation during liver transplantation in patients at high risk forsplenic artery steal syndrome

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