肝移植术行脾动脉环阻预防脾动脉盗血综合征的效果及其安全性

Evaluation of prophylactic outcomes and clinical reliability on splenic artery banding for splenic artery steal syndrome in recipients after orthotopic liver transplantation

目的：探讨脾动脉环阻术（ splenic artery banding， SAB）预防肝移植术后脾动脉盗血综合征（ splenic artery ateal syndrome， SASS）的效果及其安全性。方法2004－01至2013－12，对127例肝硬化、脾脏增大、术前脾动脉直径／肝动脉直径（SA／CHA）≥1．5、术中HA血流＜30 cm／s的肝移植患者（SASS高危者）采用预防性SAB（干预组），观察其预防SASS效果及安全性。分析术中HA血流≥30 cm／s未接受环阻术的191例患者（对照组）手术前后情况，同时对两组部分资料进行比较。结果干预组患者处理后肝动脉（CHA）血流量立即改善，环阻前（19．34±5．45） cm／s，环阻后（45．89±9．13）cm／s， P＜0．001；阻力指数（ RI）全部恢复到正常水平（0．5～0．8），移植术后无SASS发生，亦未观察到移植术后受者动脉相关并发症。而对照组术后发现SASS 17例（8．90％），其中11例继发肝动脉血栓形成。结论高风险患者预防性SAB具有可靠的疗效和安全性。

Objective To investigate the criteria of prophylaxis of splenic artery banding （ SAB） on splenic artery steal syn-drome （ SASS） , and to evaluate their clinical outcomes and reliability in recipients undergoing orthotopic liver transplantation （ OLT） . Methods 127 consecutive OLT recipients suffered from liver cirrhosis combined with splenomegaly.Ratio diameter of pre-OLT splen-ic artery（SA） to which of common hepatic artery （SA/CHA） ≥1.5 and intra-OLT peak systolic velocity （PSV）〈30 cm/s had been performed SAB in this hospital between January, 2004 and December, 2013.We reviewed their clinical data of clinical outcomes and safety.Results The sluggish and dim PSV of the patent hepatic artery increased immediately in the mean PSV from （19.34 ±5.45） cm/s to （45.89 ±9.13）cm/s （P〈0.001）, and resistivity index （RI） of HA rehabilitated to reasonable level （0.5-0.8） after inter-vention, without SASS or any artery-related complication detected.However, there were 17 cases SASS out of 191 patients exempted from SAB because of their intra-OLT PSV≥30 cm/s, and 11 cases of them secondary by HA thrombosis.Conclusions SASS is an important but often underdiagnosed cause of graft ischemia after OLT.Prophylactic SA banding deserves to be applied in patients ris-king on SASS for satisfactory results and reasonable safety.