CAJ | 학술논문

目的：探讨脾动脉环阻术（ splenic artery banding， SAB）预防肝移植术后脾动脉盗血综合征（ splenic artery ateal syndrome， SASS）的效果及其安全性。方法2004－01至2013－12，对127例肝硬化、脾脏增大、术前脾动脉直径／肝动脉直径（SA／CHA）≥1．5、术中HA血流＜30 cm／s的肝移植患者（SASS高危者）采用预防性SAB（干预组），观察其预防SASS效果及安全性。分析术中HA血流≥30 cm／s未接受环阻术的191例患者（对照组）手术前后情况，同时对两组部分资料进行比较。结果干预组患者处理后肝动脉（CHA）血流量立即改善，环阻前（19．34±5．45） cm／s，环阻后（45．89±9．13）cm／s， P＜0．001；阻力指数（ RI）全部恢复到正常水平（0．5～0．8），移植术后无SASS发生，亦未观察到移植术后受者动脉相关并发症。而对照组术后发现SASS 17例（8．90％），其中11例继发肝动脉血栓形成。结论高风险患者预防性SAB具有可靠的疗效和安全性。
목적：탐토비동맥배조술（ splenic artery banding， SAB）예방간이식술후비동맥도혈종합정（ splenic artery ateal syndrome， SASS）적효과급기안전성。방법2004－01지2013－12，대127례간경화、비장증대、술전비동맥직경／간동맥직경（SA／CHA）≥1．5、술중HA혈류＜30 cm／s적간이식환자（SASS고위자）채용예방성SAB（간예조），관찰기예방SASS효과급안전성。분석술중HA혈류≥30 cm／s미접수배조술적191례환자（대조조）수술전후정황，동시대량조부분자료진행비교。결과간예조환자처리후간동맥（CHA）혈류량립즉개선，배조전（19．34±5．45） cm／s，배조후（45．89±9．13）cm／s， P＜0．001；조력지수（ RI）전부회복도정상수평（0．5～0．8），이식술후무SASS발생，역미관찰도이식술후수자동맥상관병발증。이대조조술후발현SASS 17례（8．90％），기중11례계발간동맥혈전형성。결론고풍험환자예방성SAB구유가고적료효화안전성。
Objective To investigate the criteria of prophylaxis of splenic artery banding ( SAB) on splenic artery steal syn-drome ( SASS) , and to evaluate their clinical outcomes and reliability in recipients undergoing orthotopic liver transplantation ( OLT) . Methods 127 consecutive OLT recipients suffered from liver cirrhosis combined with splenomegaly.Ratio diameter of pre-OLT splen-ic artery(SA) to which of common hepatic artery (SA/CHA) ≥1.5 and intra-OLT peak systolic velocity (PSV)<30 cm/s had been performed SAB in this hospital between January, 2004 and December, 2013.We reviewed their clinical data of clinical outcomes and safety.Results The sluggish and dim PSV of the patent hepatic artery increased immediately in the mean PSV from (19.34 ±5.45) cm/s to (45.89 ±9.13)cm/s (P<0.001), and resistivity index (RI) of HA rehabilitated to reasonable level (0.5-0.8) after inter-vention, without SASS or any artery-related complication detected.However, there were 17 cases SASS out of 191 patients exempted from SAB because of their intra-OLT PSV≥30 cm/s, and 11 cases of them secondary by HA thrombosis.Conclusions SASS is an important but often underdiagnosed cause of graft ischemia after OLT.Prophylactic SA banding deserves to be applied in patients ris-king on SASS for satisfactory results and reasonable safety.