通过脾脏形态及其侧支循环的影像学改变评估肝移植对门脉高压脾大的作用

To evaluate the role of OLT on splenomegaly of portal hypertension by the radiological changes of splenic morphology and collaterals

目的观察肝硬化门脉高压脾大患者肝移植术前后脾脏及其侧支循环的影像学变化，进而探讨肝移植对门脉高压的疗效及作用。方法选取2005年4月至2011年5月在中山大学附属第三医院56例因门脉高压症行肝移植的患者，根据术后随访时间分为5组：A组（≤3个月）；B组（〉3—6个月）；C组（〉6～12个月）；D组（〉12～24个月）；E组（〉24个月）。同时选取20名健康人作为正常对照组（F组）。分别测量及观察6组患者肝移植术前后脾脏的宽度、厚度、长径、体积、门静脉直径、脾静脉直径及侧支循环开放情况。结果肝移植术后A～E组脾脏体积的缩小幅度分别为25．4％、27．8％、21．9％、25．2％、27．7％，且与正常组比较仍处于肿大状态（P〈0．05）。肝移植术后31例（81．6％，31／36）患者食管胃底静脉曲张恢复正常；10例开放的附脐静脉消失；5例腹膜后静脉曲张持续存在。结论肝移植能有效的治疗肝硬化门脉高压脾大及侧支循环开放，移植术后前3个月内脾脏体积缩小约25％，之后变化不大。肝移植术后多数食管胃底静脉曲张恢复正常，脾大与脾静脉、腹膜后静脉曲张可平行存在。正确了解肝移植术后脾脏及其侧支循环的变化，可评估肝移植对门脉高压的疗效，有助于提高患者的远期生存质量。

Objective To explore the effect of orthotopic liver transplantation （OLT） on portal hypertension by observing the radiological changes of splenic volume and collaterals before and after OLT. Methods In our hospital 56 patients performing OLT due to cirrhosis, portal hypertension and splenomegaly were classified into five groups according to their following-up time： A （ 〈 3 months ） , B （ 〉3-6 months）, C （ 〉6- 12 months）, D （ 〉 12-24 months）, and E （ 〉24 months）. Twenty health people were chose as control group （F）. The splenic width, thickness, length, volume, diameter of portal and splenic vein and collaterals were measured and observed in every patient of six groups before and after OLT respeetively. Results After OLT, the splenic volume decreased by 25.4% ,27.8% ,21.9% ,25.2% , 27.7% in five groups respectively, which was still larger than the normal group （P〈0.05）. Gastroesophageal varices in 31 cases （81.6% ,31/36） became normal after OLT. The opened umbilical vein disappeared and the postperitoneal varices persisted in five cases after OLT. Conclusions Splenomegaly and opened collaterals can be relieved by OLT effectively. The splenic volume didn＇t change obviously until it decreased by 25% in the three months after OLT. Gastroesophageal varices can be removed in most of patients after OLT. The splenomegaly could last paralled with the splenic vein and postperitoneal varices after OLT. After OLT, correct disposal of splenic and collateral changes could improve the success rate and the long-term treatment effect of OLT.