Sato Yoshinobu, Yamamoto Satoshi, Oya Hiroshi, Nakatsuka Hideki, Tsukahara Akihiro, Kobayashi Takashi, Watanabe Takaoki, Hatakeyama Katsuyoshi
First Department of Surgery, School of Medicine, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
Hepatogastroenterology. 2002 Nov-Dec;49(48):1652-5.
BACKGROUND/AIMS: We investigated the effects of splenectomy on the reduction of excessive portal hypertension immediately after adult living-related donor liver transplantation, paying particular attention to peritransplanted portal pressure in seven adult patients.
We studied the relationship between portal hypertension and hyperbilirubinemia in small-for-size graft liver transplantation.
In the three cases, the portal pressures increased beyond 30 cmH2O after living-related donor liver transplantation, despite the right lobe graft, and these patients underwent splenectomy. After splenectomy, their portal pressures decreased below 25 cmH2O. The portal pressure underwent auxiliary orthotopic partial liver transplantation due to the hypercitrullinemia and did not change after surgery (9.5 to 11.5 cmH2O). Interestingly, the hyperbilirubinemia occurring after living-related donor liver transplantation were as the primary result of direct bilirubin except for the patient with citrullinemia. The posttransplanted portal pressures were controlled below 25 cmH2O in all patients, with their peak serum total bilirubin levels not exceeding 15 mg/dL, and the patients were discharged without major complications. Three patients underwent splenectomy, and did not suffer from serious infection. The reduction in excessive portal hypertension after living-related donor liver transplantation might prevent liver injury and post-transplant hyperbilirubinemia.
However, splenectomy remains a life-threatening factor. Therefore, transplant surgeons encountering living-related donor liver transplantation must continue to seek out additional solutions to problems with excessive portal hypertension.
背景/目的：我们研究了脾切除术对成人活体肝移植术后即刻降低门静脉高压的效果，特别关注了7例成年患者移植周围门静脉压力。
我们研究了小体积移植肝移植中门静脉高压与高胆红素血症之间的关系。
在3例患者中，尽管接受了右叶移植，但活体肝移植后门静脉压力升高超过30 cmH₂O，这些患者接受了脾切除术。脾切除术后，他们的门静脉压力降至25 cmH₂O以下。由于高瓜氨酸血症，门静脉压力接受了辅助原位部分肝移植，术后未发生变化（9.5至11.5 cmH₂O）。有趣的是，除瓜氨酸血症患者外，活体肝移植后发生的高胆红素血症主要是直接胆红素升高的结果。所有患者移植后门静脉压力均控制在25 cmH₂O以下，血清总胆红素峰值水平不超过15 mg/dL，患者均无严重并发症出院。3例患者接受了脾切除术，未发生严重感染。活体肝移植后过高门静脉压力的降低可能预防肝损伤和移植后高胆红素血症。
然而，脾切除术仍然是一个危及生命的因素。因此，进行活体肝移植的外科医生必须继续寻找解决门静脉高压问题的其他方法。
