肝移植术后脾动脉盗血综合征的诊治与预防

Diagnosis and prevention of splenic artery steal syndrome after liver transplantation

目的探讨肝移植术后脾动脉盗血综合征(SASS)的诊断、治疗及预防。方法回顾性分析2011年11月-2017年4月在吉林大学第一医院159例接受肝移植患者的临床资料,术后并发SASS 5例,预防性脾动脉结扎(SAL)4例。5例发生SASS的患者均为早期通过多普勒超声疑似诊断,肝动脉造影确诊,根据脾动脉内径采用脾动脉栓塞(SAE)4例,SAL 1例。将术前血小板<50×10~9/L、胰腺上缘脾动脉中段脾动脉内径(SA)/肝总动脉内径(CHA)>1.5、门静脉流速>50 cm/s作为预防性脾动脉结扎的指征。4例符合高风险标准的患者,术中于胰腺上缘主干处预防性行SAL。结果 4例术中预防性SAL患者术后无一例发生SASS,恢复良好;5例术后确诊SASS患者,1例合并肝动脉血栓,经肝动脉溶栓后再通,联合行SAE,3例患者单纯行SAE,1例行SAL,均恢复顺利。结论 SASS是肝移植术后严重并发症,高风险患者预防性脾动脉结扎具有可靠的疗效和安全性,及时诊断移植物早期SASS并实施脾动脉栓塞或脾动脉结扎是有效的补救措施,避免其严重的后果。

Objective To study the techniques in diagnosis and prevention of splenic artery steal syndrome（SASS） after liver transplantation（LT）. Methods A total of 159 patients who underwent LT in our hospital between Nov 2011 and Apr 2017 were studied,including five patients identified as SASS, and four patients receiving splenic artery ligation（SAL） as a way to prevent SASS. Patients with SASS were diagnosed by Doppler ultrasound and confirmed by subsequent digital subtraction angiography（DSA）. Four patients with SASSs were treated with splenic artery embolization（SAE）, and 1 patients with SASS was treated with SAL. Platelet count 50×10^9/L,the cealibre ratio of the splenic artery（SA）and common hepatic artery（CHA） 1.5, portal vein velocity 50 cm/s were employed as the indication for SAL. Four patients at high risk for SASS received SAL to prevent SASS（pre-SAL）. Results None of the 4 patients who received pre-SAL developed SASS, and all of the 4 patients recovered smoothly. Three of five patients diagnosed as SASS after LT received SAE, and one patient with SASS received SAL. Onepatient developed hepatic artery thrombosisand received thrombolysis and SAE. All of the five patients with SASS recovered smoothly. Conclusion SASS is a serious complication after LT. Pre-SAL is an effective way to prevent SASS in patients at high risk. Timely diagnosis in early stage and salvage intervention of SAE or SAL are effective to prevent further progression and devastating consequences.