肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效分析

Curative effect analysis of preventive splenic artery ligation during liver transplantation in patients at high risk for splenic artery steal syndrome

目的探讨肝移植术中预防性脾动脉结扎对脾动脉窃血高危患者的疗效及其安全性。方法纳入脾动脉窃血高危患者68例(存在以下任一点即可:①脾动脉直径>5 mm;②脾动脉直径/肝固有动脉直径>1.5;③脾体积>829 ml),根据肝移植术中是否结扎脾动脉分为结扎组(22例)和非结扎组(46例),比较两组围术期相关临床资料。结果两组相比,结扎组受者术后无一例发生脾动脉窃血,明显低于非结扎组(21.74%),差异具有统计学意义(χ2=4.008,P<0.05)。术后结扎组受者的脾动脉直径、脾动脉直径/肝固有动脉直径、脾体积明显低于非结扎组,差异有统计学意义(P<0.05)。术后结扎组的肝动脉流速(47.53±2.17)cm/s明显高于非结扎组(31.10±1.14)cm/s,差异有统计学意义(t=7.384,P<0.001);两组术前术后的门静脉流速均无统计学差异。肝移植术后1、2、3周时,结扎组的丙氨酸转移酶、总胆红素水平明显低于非结扎组,差异有统计学意义(P<0.05)。结论对于脾动脉窃血高危受者,肝移植术中预防性结扎脾动脉是安全有效的。

Objective To investigate the efficacy and safety of preventive splenic artery ligation during liver transplantation in patients at high risk for splenic artery steal syndrome.Methods Sixty eight patients with high risk of spleen artery stealing(meet any points of the following is eligible,①The diameter of the spleen artery>5 mm;②The diameter of the spleen artery/the diameter of the proper hepatic artery>1.5;③The spleen volume>829 ml)were included.According to whether the splenic artery was ligated during liver transplantation,patients were divided into ligated group(22 cases)and non-ligated group(46 cases).The clinical data of perioperative period were compared between the two groups.Results Compared with the two groups,none of the recipients in the ligation group had splenic artery stealing after surgery,which was significantly lower than that in the non-ligated group(21.74%),and the difference was statistically significant(χ2=4.008,P<0.05)。The postoperative splenicspleen artery diameter,splenic artery diameter/proper hepatic artery diameter,and spleen volume of the recipients in the ligation group were significantly lower than those in the non-ligated group,and the differences were statistically significant(P<0.05).The postoperative hepatic arterial flow velocity(47.53±2.17)cm/s in the ligation group was significantly higher than that in the non-ligated group(31.10±1.14)cm/s,and the difference was statistically significant(t=7.384,P<0.001).There was no statistical difference in portal flow velocity before and after surgery between two groups.At 1 week,2 weeks and 3 weeks after liver transplantation,the levels of alanine aminotransferase and total bilirubin in the ligated group were significantly lower than those in the non-ligated group,and the differences were statistically significant(P<0.05).Conclusion For patients at high risk of splenic artery steal syndrome,prophylactic ligation of the splenic artery during liver transplantation is safe and effective.