CAJ | 학술논문

目的探讨肝移植术后发生脾动脉窃血综合征(SASS)的危险因素及其相关防治策略.方法回顾性分析2005年6月至2013年6月于天津市第一中心医院行成人原位全肝移植术后确诊的SASS患者24例,随机抽取同时段未发生SASS的肝移植术后患者96例为对照组.收集SASS组和对照组患者肝移植术前脾动脉直径、肝动脉直径、供肝质量、受者体重、热缺血时间、冷缺血时间、术中无肝期和手术时间等临床资料;收集SASS组患者肝移植术后第1天、确诊前1天、确诊(治疗)当天、治疗后第1、3、7、14天及对照组肝移植术后第1、3、5、7、10、14天的肝动脉收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、血流阻力指数(RI)及门静脉平均速度(PVF)等肝脏血流动力学参数超声检查结果,统计分析各项测量指标是否存在差异.结果 SASS组与对照组患者的肝移植术前脾动脉直径与肝动脉直径比值、供肝质量、供肝质量与受者体重比值(GRWR)分别为1.26和1.00、1 032 g和1 075 g、(1.40±0.30)％和(1.82±0.21)％,SASS组与对照组间均存在明显差异(Z=-6.40、Z=-2.22、t=-6.50,P值均＜0.05);SASS组与对照组的热缺血时间、冷缺血时间、术中无肝期和手术时间分别为3.5 min和4.0 min、10.25 h和10.10 h、43 min和45 min、8.7h和8.7h,SASS组与对照组间均无差异(P值均＞0.05).SASS组肝移植术后早期肝动脉RI渐进性升高,但接受脾动脉弹簧钢圈栓塞治疗后明显降低(P＜0.01),治疗后两周趋于稳定.结论脾动脉直径与肝动脉直径比值和GRWR分别是SASS的正性与负性危险因素;肝移植术后早期肝动脉RI渐进性升高是发生SASS的预警信号;脾动脉主干弹簧钢圈栓塞术是治疗肝移植术后SASS的有效方法.
목적 탐토간이식술후발생비동맥절혈종합정(SASS)적위험인소급기상관방치책략.방법 회고성분석2005년6월지2013년6월우천진시제일중심의원행성인원위전간이식술후학진적SASS환자24례,수궤추취동시단미발생SASS적간이식술후환자96례위대조조.수집SASS조화대조조환자간이식술전비동맥직경、간동맥직경、공간질량、수자체중、열결혈시간、랭결혈시간、술중무간기화수술시간등림상자료;수집SASS조환자간이식술후제1천、학진전1천、학진(치료)당천、치료후제1、3、7、14천급대조조간이식술후제1、3、5、7、10、14천적간동맥수축기봉치류속(PSV)、서장말기혈류속도(EDV)、혈류조력지수(RI)급문정맥평균속도(PVF)등간장혈류동역학삼수초성검사결과,통계분석각항측량지표시부존재차이.결과 SASS조여대조조환자적간이식술전비동맥직경여간동맥직경비치、공간질량、공간질량여수자체중비치(GRWR)분별위1.26화1.00、1 032 g화1 075 g、(1.40±0.30)％화(1.82±0.21)％,SASS조여대조조간균존재명현차이(Z=-6.40、Z=-2.22、t=-6.50,P치균＜0.05);SASS조여대조조적열결혈시간、랭결혈시간、술중무간기화수술시간분별위3.5 min화4.0 min、10.25 h화10.10 h、43 min화45 min、8.7h화8.7h,SASS조여대조조간균무차이(P치균＞0.05).SASS조간이식술후조기간동맥RI점진성승고,단접수비동맥탄황강권전새치료후명현강저(P＜0.01),치료후량주추우은정.결론 비동맥직경여간동맥직경비치화GRWR분별시SASS적정성여부성위험인소;간이식술후조기간동맥RI점진성승고시발생SASS적예경신호;비동맥주간탄황강권전새술시치료간이식술후SASS적유효방법.
Objective To discuss the risk factors of splenic arterial steal syndrome (SASS) after orthotopic liver transplantation.Methods Twenty-four cases who confirmed SASS after liver transplantation in Tianjin First Central Hospital between June 2005 and June 2013 were analyzed retrospectively.Another 96 cases were selected randomly from those patients of the same time with no complication of SASS patients postoperatively as control group.Clinical data of two groups including diameter of splenic artery and hepatic artery preoperatively, weight of graft, weight of recipients, cold/warm ischemia time, an hepatic period and operation time and so on were collected.Others including hepatic artery peak systolic velocity (PSV), end diastolic velocity (EDV) ,blood flow resistance index and portal vein average velocity(PVF) on the first day after liver transplantation, the day before diagnosis, the day when diagnosed, the 1,3,7 days after treatment in SASS group and on 1,3,7,9,11,14 days after liver transplantation in control group.Statistical analysis were made between two groups.Results The splenic artery/hepatic artery ratio preoperatively and weight of donor liver,and the GRWR in SASS group and control group were 1.26 and 1.00, 1 032 g and 1 075 g,(1.40 ± 0.30) ％ and (1.82 ± 0.21) ％ respectively, with significantly statistical differences (Z =-6.40,Z =-2.22,t =-6.50;all P ＜ 0.05).The warm ischemia time, the cold ischemia time, the anhepatic period and operation time in SASS group and control group were 3.5 minutes and 4.0 minutes, 10.25 hours and 10.10 hours,43 minutes and 45 minutes, 8.7 hours and 8.7 hours, with no significantly statistical differences(all P ＞ 0.05).RI of hepatic went up gradually in the early time after transplantation while dropped obviously when spleen artery spring coils embolization was received (P ＜ 0.01) and trended to stable two weeks later.Conclusions Splenic artery/hepatic artery ratio and GRWR are the positive and negative risk factors respectively for SASS.The gradual rising of hepatic RI in the early time after transplantation may be the warning signal SASS and spleen artery spring coils embolization is the effective strategy for SASS after liver transplantation.