中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
43期
3058-3061
,共4页
梁莹莹%王劲%单鸿%颜荣华%胡冰%姜在波%何炳均%刘静静%任泠斓%邵硕
樑瑩瑩%王勁%單鴻%顏榮華%鬍冰%薑在波%何炳均%劉靜靜%任泠斕%邵碩
량형형%왕경%단홍%안영화%호빙%강재파%하병균%류정정%임령란%소석
肝移植%脾大%侧支循环
肝移植%脾大%側支循環
간이식%비대%측지순배
Liver Transplantation%Splenomegaly%Collateral Circulation
目的 观察肝硬化门脉高压脾大患者肝移植术前后脾脏及其侧支循环的影像学变化,进而探讨肝移植对门脉高压的疗效及作用.方法 选取2005年4月至2011年5月在中山大学附属第三医院56例因门脉高压症行肝移植的患者,根据术后随访时间分为5组:A组(≤3个月);B组(＞3 ～6个月);C组(＞6～12个月);D组(＞12～24个月);E组(＞24个月).同时选取20名健康人作为正常对照组(F组).分别测量及观察6组患者肝移植术前后脾脏的宽度、厚度、长径、体积、门静脉直径、脾静脉直径及侧支循环开放情况.结果 肝移植术后A～E组脾脏体积的缩小幅度分别为25.4％、27.8％、21.9％、25.2％、27.7％,且与正常组比较仍处于肿大状态(P＜0.05).肝移植术后31例(81.6％,31/36)患者食管胃底静脉曲张恢复正常;10例开放的附脐静脉消失;5例腹膜后静脉曲张持续存在.结论 肝移植能有效的治疗肝硬化门脉高压脾大及侧支循环开放,移植术后前3个月内脾脏体积缩小约25％,之后变化不大.肝移植术后多数食管胃底静脉曲张恢复正常,脾大与脾静脉、腹膜后静脉曲张可平行存在.正确了解肝移植术后脾脏及其侧支循环的变化,可评估肝移植对门脉高压的疗效,有助于提高患者的远期生存质量.
目的 觀察肝硬化門脈高壓脾大患者肝移植術前後脾髒及其側支循環的影像學變化,進而探討肝移植對門脈高壓的療效及作用.方法 選取2005年4月至2011年5月在中山大學附屬第三醫院56例因門脈高壓癥行肝移植的患者,根據術後隨訪時間分為5組:A組(≤3箇月);B組(＞3 ～6箇月);C組(＞6～12箇月);D組(＞12～24箇月);E組(＞24箇月).同時選取20名健康人作為正常對照組(F組).分彆測量及觀察6組患者肝移植術前後脾髒的寬度、厚度、長徑、體積、門靜脈直徑、脾靜脈直徑及側支循環開放情況.結果 肝移植術後A～E組脾髒體積的縮小幅度分彆為25.4％、27.8％、21.9％、25.2％、27.7％,且與正常組比較仍處于腫大狀態(P＜0.05).肝移植術後31例(81.6％,31/36)患者食管胃底靜脈麯張恢複正常;10例開放的附臍靜脈消失;5例腹膜後靜脈麯張持續存在.結論 肝移植能有效的治療肝硬化門脈高壓脾大及側支循環開放,移植術後前3箇月內脾髒體積縮小約25％,之後變化不大.肝移植術後多數食管胃底靜脈麯張恢複正常,脾大與脾靜脈、腹膜後靜脈麯張可平行存在.正確瞭解肝移植術後脾髒及其側支循環的變化,可評估肝移植對門脈高壓的療效,有助于提高患者的遠期生存質量.
목적 관찰간경화문맥고압비대환자간이식술전후비장급기측지순배적영상학변화,진이탐토간이식대문맥고압적료효급작용.방법 선취2005년4월지2011년5월재중산대학부속제삼의원56례인문맥고압증행간이식적환자,근거술후수방시간분위5조:A조(≤3개월);B조(＞3 ～6개월);C조(＞6～12개월);D조(＞12～24개월);E조(＞24개월).동시선취20명건강인작위정상대조조(F조).분별측량급관찰6조환자간이식술전후비장적관도、후도、장경、체적、문정맥직경、비정맥직경급측지순배개방정황.결과 간이식술후A～E조비장체적적축소폭도분별위25.4％、27.8％、21.9％、25.2％、27.7％,차여정상조비교잉처우종대상태(P＜0.05).간이식술후31례(81.6％,31/36)환자식관위저정맥곡장회복정상;10례개방적부제정맥소실;5례복막후정맥곡장지속존재.결론 간이식능유효적치료간경화문맥고압비대급측지순배개방,이식술후전3개월내비장체적축소약25％,지후변화불대.간이식술후다수식관위저정맥곡장회복정상,비대여비정맥、복막후정맥곡장가평행존재.정학료해간이식술후비장급기측지순배적변화,가평고간이식대문맥고압적료효,유조우제고환자적원기생존질량.
Objective To explore the effect of orthotopic liver transplantation (OLT) on portal hypertension by observing the radiological changes of splenic volume and collaterals before and after OLT.Methods In our hospital 56 patients performing OLT due to cirrhosis,portal hypertension and splenomegaly were classified into five groups according to their following-up time:A (≤3 months),B (＞3-6 months),C (＞6-12 months),D (＞12-24 months),and E (＞24 months).Twenty health people were chose as control group (F).The splenic width,thickness,length,volume,diameter of portal and splenic vein and collaterals were measured and observed in every patient of six groups before and after OLT respectively.Results After OLT,the splenic volume decreased by 25.4％,27.8％,21.9％,25.2％,27.7％ in five groups respectively, which was still larger than the normal group (P＜0.05).Gastroesophageal varices in 31 cases (81.6％,31/36) became normal after OLT.The opened umbilical vein disappeared and the postperitoneal varices persisted in five cases after OLT.Conclusions Splenomegaly and opened collaterals can be relieved by OLT effectively.The splenic volume didn't change obviously until it decreased by 25％ in the three months after OLT.Gastroesophageal varices can be removed in most of patients after OLT.The splenomegaly could last paralled with the splenic vein and postperitoneal varices after OLT.After OLT,correct disposal of splenic and collateral changes could improve the success rate and the long-term treatment effect of OLT.
