肝移植治疗脾功能亢进相关终末期肝病*

背景：肝移植已成为治疗脾亢相关终末期肝病最理想的方法,行肝移植过程中保留脾脏,是否会出现移植后脾功能亢进相关问题,目前尚无统一的认识。 目的：观察肝移植治疗脾功能亢进相关终末期肝病移植后脾功能的恢复过程。 方法：纳入肝移植治疗终末期肝病患者63例,按有无脾功能亢进分为脾亢组和非脾亢组。比较两组移植后血小板计数、彩超测定脾脏上下径、厚度、门静脉直径及随访15个月的结果。 结果与结论：纳入患者63例,死亡8例,55例进入结果分析。其中,肝移植并行切脾者4例,仅1例存活。脾亢组移植手术结束时血小板较移植前明显降低,移植后3 d降至最低,而后逐渐上升,移植后7 d明显增加(P < 0.05),稳定至15个月;非脾亢组血小板移植后5 d降至最低,17 d达到移植前水平,两组比较差异均有显著性意义(P < 0.05)。移植后7 d脾脏上下径及厚度开始明显减小(P < 0.05),3个月脾静脉直径明显减小(P < 0.05),至15个月稳定,患者均无门静脉高压曲张静脉破裂出血史。说明肝移植过程中若无绝对切除脾脏的适应症,应尽量保留脾脏。 关键词：脾功能亢进;肝移植;终末期肝病;门静脉;临床观察 doi:10.3969/j.issn.1673-8225.2012.05.003

Liver transplantation for end-stage liver disease with hypersplenism

BACKGROUND: Liver transplantation has become the most effective method to treat end-stage liver disease with hypersplenism. However, it is not certain that whether hypersplenism can occur when the speen is kept in the process of liver transplantation. OBJECTIVE: To observe the recovery of spleen function after liver transplantation in end-stage liver disease with hypersplenism. METHODS: Sixty-three cases of end-stage liver disease treated with liver transplantation were selected, and they were divided into two groups: hypersplenism group and non-hypersplenism group. Postoperative changes of the two groups in platelets, diameter from top to bottom measured by color ultrasound, intercostal thickness, splenic vein diameter at the portal vein were observed, and all the patients were followed-up for 15 months. RESULTS AND CONCLUSION: Of the 63 cases selected, eight cases died, and 55 cases were analyzed. Only one case survived in the four cases which underwent parallel splenectomy. When surgery ended, platelets level in the hypersplenism group was significantly lower than that before surgery, and decreased to its lowest point at day 3 after surgery, then gradually increased,  obviously increased at day 7 (P < 0.05), and kept stable until month 15. Platelets level in the non-hypersplenism group dropped to its lowest point at day 5 after surgery, and reached the preoperative level at day 17. There were significant differences between the two groups (P < 0.05). In the hypersplenism group at day 7 after surgery, spleen diameter from top to bottom and thickness began to reduce significantly (P < 0.05); splenic vein diameter significantly reduced at month 3 (P < 0.05), and kept stable until month 15. In the 55 cases, no case was found portal hypertension and variceal bleeding. These findings suggest that the speen should be kept as far as possible in the process of liver transplantation if cases have no indications for splenectomy.