肝移植期间同时进行脾切除术可增强丙型肝炎病毒感染患者的抗病毒治疗效果。
Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus.
作者信息
Chu Heng-Cheng, Hsieh Chung-Bao, Hsu Kuo-Feng, Fan Hsiu-Lung, Hsieh Tsai-Yuan, Chen Teng-Wei
机构信息
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan; Division of Transplantation, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
出版信息
Am J Surg. 2015 Jan;209(1):180-6. doi: 10.1016/j.amjsurg.2014.03.004. Epub 2014 May 4.
BACKGROUND
Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated.
METHODS
Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis.
RESULTS
Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups.
CONCLUSION
Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT.
背景
肝移植（LT）中同时行脾切除术是因脾门静脉血栓形成和脓毒症增加而选择性进行的。因此，其影响应进一步研究。
方法
160例肝移植患者中，仅40例行同期脾切除术。采用回顾性分析比较脾切除组和非脾切除组的临床病理特征及预后。
结果
虽然两组情况相似，术中及术后数据无显著差异，但非脾切除组男性患者更多。然而，脾切除组在移植后1个月和6个月时血小板和白细胞计数显著更高，丙型肝炎病毒抗病毒治疗完成率更高。此外，3例患者在术后随访期间发生门静脉或脾静脉血栓形成，但两组的总生存率无显著差异。
结论
肝移植中同期脾切除术可安全实施，尤其是在丙型肝炎病毒肝硬化、小体积移植物、脾功能亢进和ABO血型不相容（ABO - 不相容）肝移植患者中。
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