摘要
目的 探讨术前脾切除对肝移植治疗门脉高压症的影响及其并发症防治.方法 2008年1月至2013年1月,解放军南京军区福州总医院肝胆病中心采用原位肝移植的方法共治疗门静脉高压症（PHT）患者136例.其中术前行脾切除者19例.按手术时间随机抽取同期50例肝移植术前未行脾切除的PHT患者作为对照组.对两组患者手术时间、出血、输血、感染率、急性排斥反应发生率、胆道并发症发生率、生存率、术后血小板恢复情况及动静脉血栓形成等进行对比分析.结果 术前脾切组与未切脾组相比手术时间明显延长[（469±104） min比（398±63） min,P＜0.001）],术中出血量及输血量明显增高[（7005 ±8 513）ml比（3 594±2 079） ml,P=0.01和（6 526±7 470） ml比（3 527±2 275） ml,P=0.013）],感染率显著增高（84％比42％,P＜0.05）.术前脾切组累积生存率明显低于未切脾组（58％比86％,P＜0.05）.术后未脾切除组血小板经历一个先下降后升高的变化过程.术后10天血小板明显增加,逐渐达到移植前水平,并稳定至术后30天.两组均无门静脉及肝动脉血栓形成.结论 PHT患者肝移植术前行脾切除不但使手术难度增加,手术时间延长,而且亦使术中出血、术后感染等严重并发症的发生率和病死率增加.故应严格掌握脾切除的适应证.
Objective To study the influence of preoperative splenectomy on liver transplantation for portal hypertension and the management of complications.Methods From January 2008 to January 2013,a total of 136 patients underwent liver transplantation for portal hypertension （PHT） in Hepatobiliary Surgery Center,Fuzhou General Hospital of PLA Nanjing Military Region.Pre-liver transplantation splenectomy was carried out in 19 patients.We randomly selected according to the operation time 50 cases of liver transplantation as the control group.The operation time,bleeding,blood transfusion,infection,the incidence of acute rejection,biliary complication rate,survival rate,postoperative platelet recovery and arteriovenous thrombosis were analyzed.Results The preoperative group has longer surgical time,intraoperative blood loss,blood transfusion volume increased obviously,infection rate increased significantly compared with the control group.The accumulate survival rate of preoperative splenectomy group was significantly lower than that of the control group.The platelet count of the preoperative splenectomy group was significantly higher than that of the control group.The platelet count of both groups experienced the process of first rise after falling.Although the platelet count of the preoperative splenectomy group was higher than that of the control group,but there was no statistically significant difference.Conclusions Liver transplantation in PHT patients with previous splenectomy may lead to some unfavorable consequences including increases of technical diffculty of surgery,operative duration,intraoperative bleeding,postoperative infection and other serious complications,and surgical mortality.Therefore,splenectomy should be performed cautiously for the patients who may receive liver transplantation in the future.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2014年第8期572-576,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
高血压
门静脉
肝移植
脾切除
感染
血小板
Hypertension, portal
Liver transplantation
Splenectomy
Infection
Platelets
