摘要
目的研究脾动脉栓塞术对肝移植术后脾动脉盗血综合征(SASS)的治疗效果并评价其安全性。方法回顾性分析2016年7月至2022年3月树兰(杭州)医院放射科采用脾动脉栓塞术治疗的40例成人原位全肝移植术后SASS患者的临床资料。采用金属弹簧圈栓塞治疗24例,采用血管塞栓塞16例;合并胃左动脉栓塞7例,合并胃十二指肠动脉栓塞7例。比较患者术前与手术当日、术后1周、术后1个月肝动脉最大流速、总胆红素、肌酐、血小板和凝血酶原时间等指标。结果(1)患者行脾动脉栓塞手术当日较术前肝动脉右支血流速度[39.50(24.82,53.00)cm/s vs 16.65(0,34.98)cm/s,Z=0.61,P<0.001]和肝动脉左支血流流速[32.00(22.75,40.75)cm/s vs 21.00(0,30.00)cm/s,Z=0.32,P<0.001]明显上升,术后1个月分别上升至43.50(35.00,55.50)cm/s和35.00(30.00,44.25)cm/s,差异均有统计学意义(P<0.05)。金属弹簧圈栓塞与血管塞栓塞患者左右肝动脉血流流速差异无统计学意义(P>0.05)。(2)术后1个月,患者肌酐值与术前水平差异无统计学意义(P>0.05),但血小板显著上升[129.00(94.50,183.00)×10^(9)/L vs 50.00(30.00,99.00)×10^(9)/L],凝血酶时间缩短[12.90(12.05,14.05)s vs 14.60(13.50,15.70)s],差异均有统计学意义(P<0.05)。结论脾动脉栓塞术治疗肝移植术后SASS具有可靠的疗效及安全性,可使患者术后肝动脉血流恢复正常、肝功能得到明显改善,且并未发现其他动脉并发症或高凝导致的血栓形成相关并发症,未增加感染风险。
Objective This study aimed to assess the therapeutic effectiveness and safety of splenic artery embolization(SAE)in the management of splenic artery steal syndrome(SASS)following liver transplantation(LT).Methods A retrospective analysis was conducted on clinical data of 40 adult patients who underwent SAE for SASS after orthotopic liver transplantation between Jul.2016 and Mar.2022 at Shulan(Hangzhou)Hospital.Among them,24 cases were treated with metal spring coil embolization,while 16 cases received vascular plug embolization.Additionally,7 cases involved left gastric artery embolization,and 7 cases involved gastroduodenal artery embolization.The comparative analysis included liver artery peak flow velocity,total bilirubin,creatinine,platelet count,and prothrombin time on before surgery and the day of SAE,1 week and 1 month after SAE.Results(1)On the day of SAE,there was a significant increase in peak flow velocity of the right hepatic artery[39.50(24.82,53.00)cm/s vs 16.65(0,34.98)cm/s,Z=0.61,P<0.001]and left hepatic artery[32.00(22.75,40.75)cm/s vs 21.00(0,30.00)cm/s,Z=0.32,P<0.001]compared with the preoperative values.One month after surgery,these velocities further increased to 43.50(35.00,55.50)cm/s and 35.00(30.00,44.25)cm/s respectively,with statistically significant differences(P<0.05).There was no significant disparity in the peak flow velocities of the left and right hepatic arteries between patients treated with metal spring coil embolization and vascular plug embolization.(2)One month after surgery,the creatinine value of patients was not statistically significant different from preoperative level.However,platelet count exhibited a significant increase[50.00(30.00,99.00)×10^(9)/L vs 129.00(94.50,183.00)×10^(9)/L],while prothrombin time decreased[14.60(13.50,15.70)s vs 12.90(12.05,14.05)s],both with statistical significance.Conclusion SAE is effective and safe in treating SASS following liver transplantation.It can restore liver artery blood flow to normal and significantly improve liver function,a
作者
杨天
梁婷
宋梦晨
韩汝坤
李建勋
叶圣利
曹国洪
YANG Tian;LIANG Ting;SONG Mengchen;HAN Rukun;LI Jianxun;YE Shengli;CAO Guohong(Department of Radiology,Shulan(Hangzhou)Hospital,Hangzhou 310000,China)
出处
《肝胆胰外科杂志》
CAS
2023年第6期348-352,共5页
Journal of Hepatopancreatobiliary Surgery
关键词
肝移植
脾动脉盗血综合征
脾动脉栓塞术
肝动脉血流
liver transplantation
splenic artery steal syndrome(SASS)
splenic artery embolization
hepatic arterial flow
