摘要
目的：探讨术前脾切除对肝移植术后预后的影响。方法：采用回顾性队列研究方法。收集2004年1月至2014年1月中山大学附属第三医院收治的95例肝移植受者的临床资料。95例受者中，35例肝移植术前行脾切除联合贲门周围血管离断术，设为研究组；60例保留脾脏，直接行肝移植，设为对照组。肝移植受者均采用改良背驮式肝移植，由同一团队医师施行。观察指标：（1）术中及术后情况。（2）随访和生存情况。采用门诊和电话方式进行随访，术后3个月内每周1次，6个月内每个月1次，1年后每 3个月1次。随访内容包括复查血常规、免疫抑制剂的血药浓度、肝肾功能。超声造影或腹部CT检查监测远期并发症情况和受者生存情况。随访时间截至2016年1月。正态分布的计量资料采用±s表示，组间比较采用t检验，计数资料比较采用χ^2检验。结果：（1）两组受者术中及术后情况：两组受者均顺利施行肝移植。研究组受者手术时间、术中出血量和术中输血量分别为（483±136）min、（5 683±2 950）mL、（4 887±3 682）mL，对照组受者分别为（392±103）min、（3 522±1 885）mL、（3 455±2 630）mL，两组受者上述指标比较，差异均有统计学意义（t=3.683，4.358，2.202，P〈0.05）。研究组受者肝移植术中，6例存在门静脉血栓（1级4例、2级1例、3级 1例），对照组受者术中未发现门静脉血栓，两组比较，差异有统计学意义（χ^2=1.979，P〈0.05）。5例1、2级门静脉血栓受者均行血栓切除术，再行门静脉端端吻合，1级门静脉血栓受者中有1例再发血栓，术后给予溶栓后治愈。1例3级门静脉血栓受者术中通过行人工血管搭桥重建门静脉，术后再发血栓，予以处理。两组受者肝移植术中均未发现门静脉狭窄。研究组和对照组受者术后1、3、7 d血小板（PLT）分别为（75±60）×10^9/L和（57±32�
Objective：To investigate the influence of preoperative splenectomy on the prognosis after liver transplantation. Methods：The retrospective cohort study was conducted. The clinical data of 95 patients who underwent liver transplantation in the Third Affiliated Hospital of Sun Yatsen University between January 2004 and January 2014 were collected. Thirtyfive patients undergoing preoperative splenectomy and pericardial devascularization and 60 undergoing spleenpreserving liver transplantation were allocated into the study group and control group, respectively. All patients received modified piggyback liver transplantation by the same team. Observation indicators： （1） intra and postoperative situations; （2） followup and survival. The followup using telephone interview and outpatient examination was performed once every a week within 3 months postoperatively, once every one month within 6 months postoperatively and once every 3 months after 1 year postoperatively up to January 2016, including routine blood test, plasmadrug concentration of immunosuppressive agent and function of liver and kidney. Ultrasound and abdominal CT were used to monitor the longterm complication and survival. The measurement data with normal distribution were represented as ±s, and comparison between groups was done by the t test. Comparison of count data was done by the chisquare test. Results：（1） Intra and postoperative situations： all patients underwent successful liver transplantation. The operation time, volumes of intraoperative blood loss and blood transfusion were （483 ± 136） minutes, （5 683±2 950）mL, （4 887±3 682）mL in the study group and （392±103）minutes, （3 522±1 885）mL, （3 455±2 630）mL in the control group, respectively, with statistically significant differences between groups （t=3.683, 4.358, 2.202, P〈0.05）. Six patients in the study group had intraoperative portal vein thrombosis （PVT）, including 4 in level 1, 1 in level 2 and 1 in level 3, and no patients in the con
作者
许世磊
刘剑戎
张英才
姚嘉
曾凯宁
杨扬
陈规划
Xu Shilei;Liu Jianrong;Zhang Yingcai;Yao Jia;Zeng Kaining;Yang Yang;Chen Guihua(Department of General Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2018年第10期1008-1012,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81570593）
关键词
肝脏疾病
肝移植
脾切除术
门静脉
并发症
Liver diseases
Liver transplantation
Splenectomy
Portal vein
Complications
