中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
8期
572-576
,共5页
高血压,门静脉%肝移植%脾切除%感染%血小板
高血壓,門靜脈%肝移植%脾切除%感染%血小闆
고혈압,문정맥%간이식%비절제%감염%혈소판
Hypertension,portal%Liver transplantation%Splenectomy%Infection%Platelets
目的 探讨术前脾切除对肝移植治疗门脉高压症的影响及其并发症防治.方法 2008年1月至2013年1月,解放军南京军区福州总医院肝胆病中心采用原位肝移植的方法共治疗门静脉高压症(PHT)患者136例.其中术前行脾切除者19例.按手术时间随机抽取同期50例肝移植术前未行脾切除的PHT患者作为对照组.对两组患者手术时间、出血、输血、感染率、急性排斥反应发生率、胆道并发症发生率、生存率、术后血小板恢复情况及动静脉血栓形成等进行对比分析.结果 术前脾切组与未切脾组相比手术时间明显延长[(469±104) min比(398±63) min,P＜0.001)],术中出血量及输血量明显增高[(7005 ±8 513)ml比(3 594±2 079) ml,P=0.01和(6 526±7 470) ml比(3 527±2 275) ml,P=0.013)],感染率显著增高(84％比42％,P＜0.05).术前脾切组累积生存率明显低于未切脾组(58％比86％,P＜0.05).术后未脾切除组血小板经历一个先下降后升高的变化过程.术后10天血小板明显增加,逐渐达到移植前水平,并稳定至术后30天.两组均无门静脉及肝动脉血栓形成.结论 PHT患者肝移植术前行脾切除不但使手术难度增加,手术时间延长,而且亦使术中出血、术后感染等严重并发症的发生率和病死率增加.故应严格掌握脾切除的适应证.
目的 探討術前脾切除對肝移植治療門脈高壓癥的影響及其併髮癥防治.方法 2008年1月至2013年1月,解放軍南京軍區福州總醫院肝膽病中心採用原位肝移植的方法共治療門靜脈高壓癥(PHT)患者136例.其中術前行脾切除者19例.按手術時間隨機抽取同期50例肝移植術前未行脾切除的PHT患者作為對照組.對兩組患者手術時間、齣血、輸血、感染率、急性排斥反應髮生率、膽道併髮癥髮生率、生存率、術後血小闆恢複情況及動靜脈血栓形成等進行對比分析.結果 術前脾切組與未切脾組相比手術時間明顯延長[(469±104) min比(398±63) min,P＜0.001)],術中齣血量及輸血量明顯增高[(7005 ±8 513)ml比(3 594±2 079) ml,P=0.01和(6 526±7 470) ml比(3 527±2 275) ml,P=0.013)],感染率顯著增高(84％比42％,P＜0.05).術前脾切組纍積生存率明顯低于未切脾組(58％比86％,P＜0.05).術後未脾切除組血小闆經歷一箇先下降後升高的變化過程.術後10天血小闆明顯增加,逐漸達到移植前水平,併穩定至術後30天.兩組均無門靜脈及肝動脈血栓形成.結論 PHT患者肝移植術前行脾切除不但使手術難度增加,手術時間延長,而且亦使術中齣血、術後感染等嚴重併髮癥的髮生率和病死率增加.故應嚴格掌握脾切除的適應證.
목적 탐토술전비절제대간이식치료문맥고압증적영향급기병발증방치.방법 2008년1월지2013년1월,해방군남경군구복주총의원간담병중심채용원위간이식적방법공치료문정맥고압증(PHT)환자136례.기중술전행비절제자19례.안수술시간수궤추취동기50례간이식술전미행비절제적PHT환자작위대조조.대량조환자수술시간、출혈、수혈、감염솔、급성배척반응발생솔、담도병발증발생솔、생존솔、술후혈소판회복정황급동정맥혈전형성등진행대비분석.결과 술전비절조여미절비조상비수술시간명현연장[(469±104) min비(398±63) min,P＜0.001)],술중출혈량급수혈량명현증고[(7005 ±8 513)ml비(3 594±2 079) ml,P=0.01화(6 526±7 470) ml비(3 527±2 275) ml,P=0.013)],감염솔현저증고(84％비42％,P＜0.05).술전비절조루적생존솔명현저우미절비조(58％비86％,P＜0.05).술후미비절제조혈소판경력일개선하강후승고적변화과정.술후10천혈소판명현증가,축점체도이식전수평,병은정지술후30천.량조균무문정맥급간동맥혈전형성.결론 PHT환자간이식술전행비절제불단사수술난도증가,수술시간연장,이차역사술중출혈、술후감염등엄중병발증적발생솔화병사솔증가.고응엄격장악비절제적괄응증.
Objective To study the influence of preoperative splenectomy on liver transplantation for portal hypertension and the management of complications.Methods From January 2008 to January 2013,a total of 136 patients underwent liver transplantation for portal hypertension (PHT) in Hepatobiliary Surgery Center,Fuzhou General Hospital of PLA Nanjing Military Region.Pre-liver transplantation splenectomy was carried out in 19 patients.We randomly selected according to the operation time 50 cases of liver transplantation as the control group.The operation time,bleeding,blood transfusion,infection,the incidence of acute rejection,biliary complication rate,survival rate,postoperative platelet recovery and arteriovenous thrombosis were analyzed.Results The preoperative group has longer surgical time,intraoperative blood loss,blood transfusion volume increased obviously,infection rate increased significantly compared with the control group.The accumulate survival rate of preoperative splenectomy group was significantly lower than that of the control group.The platelet count of the preoperative splenectomy group was significantly higher than that of the control group.The platelet count of both groups experienced the process of first rise after falling.Although the platelet count of the preoperative splenectomy group was higher than that of the control group,but there was no statistically significant difference.Conclusions Liver transplantation in PHT patients with previous splenectomy may lead to some unfavorable consequences including increases of technical diffculty of surgery,operative duration,intraoperative bleeding,postoperative infection and other serious complications,and surgical mortality.Therefore,splenectomy should be performed cautiously for the patients who may receive liver transplantation in the future.
