中国实用外科杂志Issue(4)：440-444,5.DOI:10.7504/CJPS.ISSN1005-2208.2015.04.24
肝移植术后脾动脉盗血综合征治疗选择及安全性评价
Evaluation on outcomes and reliability of treatment options for splenic arterial steal syndrome after orthotopic liver transplantation:A report of 5 patients
摘要
Abstract
Objective To evaluate the clinical outcomes and reliability of treatment options based on diagnostic timing for splenic artery steal syndrome (SASS) in recipients underwent orthotopic liver transplantation (OLT), and to compare splenic artery coil-embolization (SAE) with other options by efficacy and reliability. Methods The incidence and clinical manifestation of SASS in 191 consecutive patients performed OLT between January 2004 and December 2013 in the General Hospital of Chinese People’s Armed Police Force were analyzed retrospectively. Those patients were suffered from liver cirrhosis combined with splenomegaly, with the ratio of pre-OLT splenic artery (SA) diameter to common hepatic artery (SA/CHA) diameter ≥1.5, but intra-OLT peak systolic velocity (PSV)≥30 cm/s. SAE, re-anastomosis HA to aorta (HTA, SA or abdominal aorta), splenic artery ligation (SAL) or splenectomy (SPT) were performed to cope with SASS depending on occurring time and aftermath of SASS. SAE with other treatments were compared by clinical outcomes and reliability. Results A total of 17 cases out of 191 patients (8.90%) were identified as SASS, and the overwhelming majority of whom (16/17, 94.11%) were detected in 15d early after OLT. The sluggish and dim PSV of the patency hepatic artery increased immediately in the mean PSV from 16.55±2.97 cm/s to 39.34±7.67 cm/s (P<0.001), and resistivity index (RI) of HA rehabilitated to reasonable level(0.5~0.8) after SAE, without any related complication detected. A total of 12 patients with hepatic artery thrombosis secondary to SASS were performed embolectomy or thrombolysis followed by HTA (4 patients), SAligation (SAL, 3 patients), or splenectomy (SPT, 5 patients), while 3 of them developed requiring re-OLT. All the patients obtained satisfactory results by the salvage strategies, except 2 out of 12 patients died from liver failure. Conclusion SASS is a severe complication after OLT. As an effective salvage intervention to prevent from devastating consequence, coil-emblization of SA shortly after early diagnosis is deserved to be introduced for satisfactory results and reasonable safety.关键词
脾动脉盗血综合征/肝移植/血管并发症/肝动脉/低灌注/脾动脉栓塞Key words
splenic artery steal syndrome/liver transplantation/vascular complication/hepatic artery/hypoperfusion/splenic artery embolization分类
医药卫生引用本文复制引用
邹卫龙,张薇,任秀昀,曾镕,陈新国,沈中阳..肝移植术后脾动脉盗血综合征治疗选择及安全性评价[J].中国实用外科杂志,2015,(4):440-444,5.基金项目
科技部863计划资助项目（No.2012AA021006）；武警总医院临床创新项目 （）
