肝移植受者合并脾动脉瘤的临床特点与诊治经验

目的 总结肝移植受者合并脾动脉瘤的临床特点和诊治经验.方法 回顾性分析2001年12月至2003年12月天津市第一中心医院移植外科实施的450例肝移植受者的临床资料、四期CT扫描及CT血管造影资料,并对临床及随访资料进行统计学分析.结果 450例受者中有20例(4.4%)被确诊合并脾动脉瘤,其中19例术前通过四期CT扫描确诊,1例为术中发现.肝移植术中未处理脾动脉瘤15例,其中2例于术后发生脾动脉瘤破裂出血,均予急诊手术(其中1例死于失血性休克).肝移植术中切除脾动脉瘤及脾脏5例,术后恢复顺利,移植肝功能良好.结论 肝硬化患者易合并发生脾动脉瘤,四期CT扫描能够准确诊断脾动脉瘤.肝移植术后早期易发生脾动脉瘤自发破裂,术中应同期予以处理.

The clinical feature, diagnosis and management of splenic artery aneurysms in liver transplant patients

Objective To summarize the clinical feature of splenic artery aneurysms(SAA)in OLT recipient,and review the experience in diagnosis and management. Methods The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients,who underwent OLT from December 2001 to December 2003 were analyzed statistically. Results Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory. Conclusions Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT,SAA rupture happens frequently, so SAA resection should be performed during transplantation.