肝移植术中脾动脉结扎对严重脾功能亢进受者预后的影响

Impact of intraoperative ligation of splenic artery on prognosis of liver transplantation on patients with severe hypersplenism

目的探讨需行肝移植术的严重脾功能亢进受者在肝移植术中同期进行脾动脉结扎对预后的影响。方法回顾性分析2016年12月至2019年2月于解放军总医院第五医学中心行肝脏移植手术受者的临床资料。共纳入206例患者,其中男性180例,女性26例,年龄(51.0±9.0)岁。51例肝移植术中行脾动脉结扎的患者设为研究组,155例术中未行脾动脉结扎的患者设为对照组。比较两组受者术后白细胞、血小板、丙氨酸氨基转移酶、总胆红素、血肌酐等指标变化,以及术后并发症发生情况。结果研究组术前及术后第1、3、7、30、90天的血小板计数均低于对照组,差异有统计学意义(P<0.05);研究组术前及术后第1、3天白细胞计数低于对照组,差异具有统计学意义(P<0.05),但是术后第5、7、30、90天两组白细胞计数差异无统计学意义(P>0.05)。两组患者术后丙氨酸氨基转移酶和总胆红素指标差异均无统计学意义(P>0.05),但是术后第3、5、7、30天研究组血肌酐水平较对照组下降,差异有统计学意义(P<0.05)。术后两组发生感染、严重急性排斥反应、胆道并发症、动脉/门静脉血栓、精神并发症的差异无统计学意义(P>0.05)。术后研究组和对照组出现急性肾损伤需要行肾脏替代治疗者分别为5例(9.8%)和2例(1.3%),差异有统计学意义(P<0.05)。结论肝移植术中行脾动脉结扎术是安全的,有益于严重脾功能亢进受者术后早期白细胞计数回升以及血肌酐指标恢复,且并不增加相关并发症发生风险。

Objective To study the impact of simultaneous ligation of splenic artery on prognosis of patients with severe hypersplenism in liver transplantation.Methods A retrospective analysis was performed on the clinical data of 206 patients who underwent liver transplantation in the Fifth Medical Center of PLA General Hospital from December 2016 to February 2019.There were 180 males and 26 females,aged(51.0±9.0)years old.Fifty-one patients underwent splenic artery ligation during liver transplantation and they were enrolled into the observation group,and 155 patients without splenic artery ligation were enrolled into the control group.The changes in white blood cells(WBC),platelets,alanine aminotransferase,total bilirubin and serum creatinine as well as the incidence of postoperative complications were compared between the two groups.Results The platelet count of the observation group was significantly lower than those of the control group before operation and on days 1,3,7,30 and 90 after operation,(all P<0.05).The WBC counts in the observation group were significantly lower than those in the control group before operation and on days 1 and 3 after operation(all P<0.05).However,there were no significant differences in the WBC counts between the two groups on days 5,7,30 and 90 after operation(all P>0.05).There were also no significant differences in alanine aminotransferase and total bilirubin indexes between the two groups after surgery(all P>0.05),but the serum creatinine levels in the observation group were significantly lower than those in the control group on days 3,5,7 and 30 after surgery(all P<0.05).There were no significant differences in the rates of infection,severe acute rejection,biliary tract complications,arterial/portal thrombosis and mental complications between the two groups(all P>0.05).The rate of renal replacement therapy for acute kidney injury in the observation group(9.8%,5/55)was significantly higher than that in the control group(1.3%,2/155)(P<0.05).Conclusion Ligation of splenic artery during liver transplantation was safe and it had a significant advantage in the early postoperative recovery of WBC count and creatinine without increasing the incidence of complications in patients with severe hypersplenism.