Egami Satoshi, Sugawara Yasuhiko, Mizuta Koichi, Kaneko Junichi, Kawarasaki Hideo, Makuuchi Masatoshi
Liver Transplantation Team, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Transplantation. 2002 Dec 15;74(11):1639-42. doi: 10.1097/00007890-200212150-00026.
The effect of pediatric partial liver transplantation on hypersplenism has not yet been clarified.
Fifty-five consecutive pediatric patients who underwent living-donor liver transplantation were analyzed. The volume of the spleen was measured by computed tomography, and the spleen volume-to-standard spleen volume ratio (R) was calculated in each patient. The platelet counts were examined preoperatively and at 1, 6, 12, 18, 24, 36, and 48 months after the operation. The rate of the decline in this ratio during 1 year was calculated, and correlations with clinical factors were examined.
The ratio decreased gradually after the operation in all of the patients except for three with an eventful postoperative course. The rate of the reduction in R within 1 year after the operation was well correlated with preoperative R (R(O); P<0.0001), which led to an equation for R at n months after the operation: R(n) =(0.31-0.21R(O) )Ln(3.3n+1)+R(O). The platelet counts increased rapidly in the patients with the uneventful postoperative course.
The normalization of spleen size can be expected with an uneventful living-donor liver transplantation. The spleen volume decreased more rapidly in patients with a larger spleen.
小儿部分肝移植对脾功能亢进的影响尚未阐明。
对55例连续接受活体供肝肝移植的小儿患者进行分析。通过计算机断层扫描测量脾脏体积，并计算每位患者的脾脏体积与标准脾脏体积之比（R）。术前及术后1、6、12、18、24、36和48个月检查血小板计数。计算该比值在1年内的下降率，并检查其与临床因素的相关性。
除3例术后病程复杂的患者外，所有患者术后该比值均逐渐下降。术后1年内R的降低率与术前R（R（O））密切相关（P<0.0001），由此得出术后n个月时R的方程：R（n） =（0.31 - 0.21R（O））Ln（3.3n + 1）+ R（O）。术后病程平稳的患者血小板计数迅速增加。
活体供肝肝移植过程顺利时，脾脏大小有望恢复正常。脾脏较大的患者脾脏体积下降更快。
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