选择性脾切除调整门静脉血流预防活体肝移植小肝综合征

Modulation of portal vein hemodynamics by selective splenectomy to prevent small-for-size syndrome in living donor liver transplantation

目的探讨选择性脾切除对活体肝移植（LDLT）受者术中门静脉血流（PVF）及术后小肝综合征（SFSS）发生率的影响。方法回顾性分析2007年9月至2008年3月26例LDLT术中PVF监测资料。对PVF〉250ml／（min·100g）者，术中同期行脾切除术；PVF％250ml／min（100g）者不行脾切除，分析选择性脾切除对PVF的影响及是否可以预防SFSS的发生。结果脾切除8例，切脾后PVF较切脾前明显降低（P〈O．01）。脾切除及未行脾切除的患者均无SFSS发生。其中脾切除患者（8例）供肝重占受者体重比显著低于未行脾切除患者（18例）（P=0．044），PVF显著高于未行脾切除患者（P〈O．01）。结论根据LDLT术中PVF监测数据，选择性脾切除可显著降低高门静脉灌注患者的PVF，对术后SFSS有预防作用。

Objective To investigate the effects of selective splenectomy on modulation of portal vein flow and prevention of small-for-size syndrome （SFSS） in living donor liver transplantation. Methods Twenty six recipients who received LDLT from September 2007 to March 2008 were reviewed. The data of the portal vein flow of these recipients were collected during the operation. Simultaneous splenectomy was performed in patients with portal blood flow ~250 ml/（min · 100g）. No splenectomy was performed when the portal blood flow was less than 250 ml/（min · 100g）. The effect of selective splenectomy on modulation of portal vein flow and whether splenectomy prevented the occurrence of SFSS were analyzed. Results The portal vein flow decreased significantly after splenectomy in 8 patients who received splenectomy （P^0.01）, No SFSS occurred in the patients with or without splenectomy. Actual graft-to-recipient weight ratio （GRWR） of patients with splenectomy was significantly smaller than those with no splenectomy （P= 0. 044）. The portal vein flow of patients with splenectomy was much higher than those with no splenectomy （P〈0. 01）. Conclusion According to the portal blood flow, selective splenectomy in LDLT decreased the portal vein flow and prevented the incidence of SFSS.