摘要
肝脏对动脉低灌注所致的缺氧非常敏感,这在肝移植术后移植物并发症(如肝动脉血栓形成、动脉瘤)中已经得到证实,可导致严重的胆道缺血性损害、移植物失功能、甚至受体死亡等严重并发症。脾动脉盗血综合征(SASS)是肝移植术后一种较少认识的动脉并发症。SASS本质是粗大的脾动脉"盗走"肝动脉血流而导致肝动脉灌注不良;不及时干预,SASS亦可导致严重的移植物并发症。目前临床上尚未形成"肝硬化性SASS"概念,更未认识其危害性。肝硬化性SASS是慢性肝病损害的结果,并加重肝损害的病理过程,临床上无特异性,多表现为基础肝病合并脾脏肿大等异常。我们通过三维CT血管成像及血管造影证实失代偿期肝硬化患者普遍存在SASS,并证实纠正SASS后肝硬化患者的肝功能指标、Child-Pugh评分、评级等显著改善,并降低了消化道出血风险。因此,该文在国际上首次提出了肝硬化性SASS概念,并证实SASS是失代偿期肝硬化患者改善肝功能的一个有效治疗靶点,可作为等待肝移植的架桥性治疗措施。
The liver is extremely susceptible to ischemia resulting from arterial hypoperfusion,which is confirmed by the graft arterial complications（such as hepatic artery thrombosis,aneurysm） after liver transplantation.Arterial hypoperfusion may lead to severe complications,e.g.ischemic biliary destruction,graft loss,even recipient death.Splenic arterial steal syndrome（SASS） is a seldom-recognized arterial complication following liver transplantation.SASS describes the phenomenon of poor arterial perfusion of hepatic parenchyma due to ＂stealing＂ or diverting of blood from the hepatic artery to the dilated splenic artery.SASS also can cause severe graft morbidity if it is not managed timely.However,there still has no clear concept of SASS in cirrhosis,moreover,the clinicians have not realized its risks to liver dysfunction.Cirrhotic SASS is a consequence of chronic liver disease,and conversely aggravates the liver damage.The clinical manifestation of cirrhotic SASS is not special,and mostly accompanied with abnormalities of poor liver function caused by underlying liver diseases and splenomegaly.We have confirmed the prevalence of SASS in patients with decompensated cirrhosis by 3-dimensional CT angiography and celiac angiography,and also have demonstrated that the liver function,Child-Pugh score and classification of cirrhotic patients can be improved after correction of SASS,as well as reducing the risks of gastrointestinal bleeding.In conclusion,this article firstly proposed the concept of cirrhotic SASS,and confirmed that SASS is an efficacious therapeutic target for improvement of liver function in patients with decompensated cirrhosis,which can be a bridging therapy for patients awaiting liver transplantation.
出处
《临床肝胆病杂志》
CAS
2011年第3期241-244,共4页
Journal of Clinical Hepatology
基金
北京市首都临床特色应用研究重点项目(D101100050010042)
中国博士后科学基金(20080441275)
关键词
肝硬化
肝移植
脾动脉盗血综合征
liver cirrhosis
liver transplantation
splenic arterial steal syndrome
