脾切除术在左半肝活体肝移植中用于降低门静脉压力的应用。

Application of splenectomy to decompress portal pressure in left lobe living donor liver transplantation.

作者信息

Ikegami Toru, Yoshizumi Tomoharu, Soejima Yuji, Ikeda Tetsuo, Kawanaka Hirofumi, Uchiyama Hideaki, Yamashita Yo-ichi, Morita Masaru, Oki Eiji, Saeki Hiroshi, Mimori Koshi, Sugimachi Keishi, Watanabe Masayuki, Shirabe Ken, Maehara Yoshihiko

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu 874-0838, Japan.

出版信息

Fukuoka Igaku Zasshi. 2013 Sep;104(9):282-9.

PMID:24364263

Abstract

This study was conducted to evaluate the impact of splenectomy in living donor liver transplantation (LDLT) using left lobe grafts. The two hundred and fifty LDLT cases were divided into two groups: Group-S (n = 98, simultaneous splenectomy) and Group-NS (n = 152). Group-S had significantly increased recipient age (54.5 +/- 10.9 years vs. 46.3 +/- 17.0 years, p < 0.01), advanced liver diseases including Child class C (64.8% vs. 51.5%, p < 0.01), higher model for end-stage liver score (17.8 +/- 8.1 vs. 15.4 +/- 5.8, p < 0.01) and more patients with hospitalized status (67.4% vs. 48.0%, p < 0.01), and smaller graft volume/standard liver volume ratio (36.5 +/- 6.1% vs. 40.2 +/- 8.2%, p < 0.01). In Group-S, splenectomy decreased portal venous (PV) pressure decreased from 23.5 +/- 5.2 mmHg to 19.2 +/- 4.8 mmHg (p < 0.01). Group-S had significantly increased PV pressure at laparotomy (24.9 +/- 5.3 mmHg vs. 22.5 +/- 6.3 mmHg, p < 0.01) and decreased PV pressure at closure (16.4 +/- 3.5 mmHg vs. 18.0 +/- 4.7 mmHg, p < 0.01), compared with Group-NS. On the 14th day after LDLT, Group-S had lower total bilirubin (5.7 +/- 6.5 mg/dl vs. 8.7 +/- 8.9 mg/dl, p < 0.01) and smaller ascites output (0.4 +/- 0.7 L/day vs. 0.7 +/- 0.4 L/day, p = 0.01) than Group-NS. The cumulative 5-year graft survival rate was 86.8% in Group-S and 76.2% in Group-NS (p = 0.03). In conclusion, splenectomy had beneficial impacts on graft outcomes in left-lobe LDLT.

摘要

本研究旨在评估活体供肝肝移植（LDLT）中使用左叶移植物时脾切除术的影响。250例LDLT病例分为两组：S组（n = 98，同期脾切除术）和NS组（n = 152）。S组受者年龄显著增加（54.5±10.9岁对46.3±17.0岁，p<0.01），包括Child C级在内的晚期肝病更多（64.8%对51.5%，p<0.01），终末期肝病模型评分更高（17.8±8.1对15.4±5.8，p<0.01），住院状态的患者更多（67.4%对48.0%，p<0.01），且移植物体积/标准肝体积比更小（36.5±6.1%对40.2±8.2%，p<0.01）。在S组中，脾切除术使门静脉（PV）压力从23.5±5.2 mmHg降至19.2±4.8 mmHg（p<0.01）。与NS组相比，S组剖腹术时PV压力显著升高（24.9±5.3 mmHg对22.5±6.3 mmHg，p<0.01），关闭时PV压力降低（16.4±3.5 mmHg对18.0±4.7 mmHg，p<0.01）。LDLT术后第14天，S组总胆红素低于NS组（5.7±6.5 mg/dl对8.7±8.9 mg/dl，p<0.01），腹水引流量更小（0.4±0.7 L/天对0.7±0.4 L/天，p = 0.01）。S组5年移植物累积生存率为86.8%，NS组为76.2%（p = 0.03）。总之，脾切除术对左叶LDLT的移植物结局有有益影响。