脾功能亢进患者肝移植术后脾功能恢复不良的原因分析

Which patients are likely to have a persistent hypersplenism after fiver transplantation for the treatment of dysfunctional fiver cirrhosis and hypersplenism

目的探讨肝移植术后脾功能亢进恢复情况，分析脾功能亢进恢复不良的原因。方法分析肝移植前存在脾功能亢进的93例患者，对术后脾功能亢进完全恢复正常的患者（正常组）和脾功能亢进不能完全恢复或不恢复的患者（异常组）进行比较，并对二组患者术后3个月的血小板计数进行相关性分析。结果术后脾功能亢进完全恢复的正常组患者为60例（64．5％），脾功能亢进不完全恢复或未恢复的患者为33例（35．5％）；正常组新肝期门静脉压力比异常组低（t=5．145；P〈0．01）；正常组术后脾静脉血流较术前明显增加（t=2．295，P〈0．05），而异常组术前术后脾静脉血流没有差异；术后3个月血小板计数与术前血小板计数、术前脾大小、新肝期门静脉压力和术后脾脏大小有相关性。结论肝硬化脾功能亢进患者在肝移植术后仍然存在脾功能亢进表现。术后早期各种原因引起的门脉压力下降不明显、脾血流量改善不良、脾脏缩小不明显等可能是导致脾功能恢复不良的因素。

Objective To evaluate the recovery of normal splenic function of hyperplenism in patients of liver transplantation. Methods In this study, 93 liver transplant patients （all with pretransplant hypersplenism） were divided into group in which the platelet count become normal and the group in which the platelet count failed to recover. Results Hypersplenism disappeared after transplantation in 60 patients （64. 5% ）, hypersplenism after transplantation persisted in 33 patients （35.5%） ; the portal vein pressure in new liver period, the splenic veinous blood flow after transplantation and the size of spleen were all significantly different between the two groups. The platelet count on three months after operation significantly correlates with pretransplant platelet count, the size of the spleen, the portal vein pressure in new liver phase and the posttransplant size of spleen. Conclusions The persistence of hypersplenism after liver transplantation is common, in may correlate with an unsatisfactory fall in portal pressure after transplantation, characteristics of splenomegaly and poor splenic venous blood flow.