脾切除对肝移植患者的影响

Effects of splenectomy on patients under going liver transplantation

目的探讨术前或术中脾切除对肝移植患者的影响。方法回顾浙江大学医学院附属第一医院1999年2月至2005年5月间收治的403例施行肝移植患者中有脾切除的29例患者的临床资料,将其分成术前脾切除组(23例)和术中脾切除组(6例),分别与同期随机抽取的未合并有脾切的肝移植患者58例作对照,就其手术时间、出血、输血、感染、急性排斥、生存率及术后血小板恢复情况等方面进行对比分析。结果术前脾切组和术中脾切组分别与无脾切组相比手术耗时明显延长,术中、术后输血明显增加,细菌感染率也显著增高。脾切后急性排斥反应发生率未见显著降低。术中脾切组累积生存率明显低于无脾切组(P=0.0001)。术后第14天各组平均血小板水平恢复正常,但是术后第30天脾切组的平均血小板水平均高于正常。结论肝移植术前或术中脾切除,对肝移植患者均无益处,脾切除应严格掌握适应证。

Objective To investigate the effects of splenectomy before or simultaneously in liver transplantation on the outcome of liver transplantation. Methods Splenectomy was performed on 29 of the consecutive 403 patients undergoing orthotopic liver transplantation （OLT） between February 1999 and May 2005, before the OTC in 23 of which and simultaneously during the OTC in 6 of which. Fifty-eight randomized selected age-matched patients undergoing OTC within the same period but without splenectomy were used as controls. The operation time, bleeding amount, transfusion amount, infection, acute rejection, survival rate, and post-operative recovery of platelet were compared between these groups. Results The average operation times of the pre-operatively splenectomized group （Group A ） and intra-operatively splenectomized group（ Group B） were 448.70 ± 100.51 minutes and 526.67 ±99.93 minutes respectively, both significantly longer than that of the non-splenectomized group （ Group C） （362.80 ± 71.65 minutes, both P 〈0. 001 ）. The intra-operative bleeding amount of the 2 splenectomized groups were both longer than that of the control group, however, not significantly. The intra-operative transfusion amounts of Group B was 3983 ±1885 ml, significantly more than that of Group C （2361 ± 1246 ml, P 〈0. 05）. The plasma transfusion amount of Group B was 8387 ±4231 ml, significantly more than that of Group C （4906 ±3108 ml, P 〈 0. 05 ）. The concentrated erythrecyte transfusion amount of Group A was 14. 2 ± 14. 6 U, significantly more than that of Group C （ 5.1 ± 6.6 U, P 〈 0. 001 ）. The bacterial infection rates of the Groups A and B were 91.3% and 100% respectively, both significantly higher than that of Group C （69.0%, both P〈0.05）. The mycotic infection rates of the 2 splenectomized groups were 13% and 33. 33% respectively, both significantly higher than that of Group C （29. 3% ）, however, both not significantly. Acute rejection rote did not occurred in the 2 splenectomized groups, and in 4 cases of the nonsplenectomized group, however, without significant differences among them. The post-operative bleeding rate of Group B was significantly higher than that of Group C （ P 〈 0.05 ）. The accumulative survival of Group C was significantly higher than that of Group B （ P = 0. 0001 ）. The platelet counts 14 and 20 days after operation of the 2 splenectomized groups were all significantly higher than those of the non-splenectomized group （ all P 〈 0.05 ）, and were higher than the normal levels in some cases. Conclusion Splenectomy does not benefit the patients undergoing liver transplantation whenever it is performed before or simultaneously in the liver transplantation.