Department of Liver Transplantation, Tianjin First Center Hospital, First Clinical Institute of Tianjin Medical University, Tianjin 300192, China.
World J Gastroenterol. 2021 Feb 21;27(7):654-665. doi: 10.3748/wjg.v27.i7.654.
The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation (LT). However, splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.
To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.
Between October 2015 and February 2019, 762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital. Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism. Among these patients, 41 received partial splenectomy during LT (PSLT group), and 43 received only LT (LT group). Patient characteristics, intraoperative parameters, and postoperative outcomes were retrospectively analyzed and compared between the two groups.
The incidence of postoperative hypersplenism (2/41, 4.8%) and recurrent ascites (1/41, 2.4%) in the PSLT group was significantly lower than that in the LT group (22/43, 51.2%; 8/43, 18.6%, respectively). Seventeen patients (17/43, 39.5%) in the LT group required two-stage splenic embolization, and further splenectomy was required in 6 of them. The operation time and intraoperative blood loss in the PSLT group (8.6 ± 1.3 h; 640.8 ± 347.3 mL) were relatively increased compared with the LT group (6.8 ± 0.9 h; 349.4 ± 116.1 mL). The incidence of postoperative bleeding, pulmonary infection, thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group, respectively.
Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.
对于晚期肝硬化和门静脉高压症，最有效的治疗方法是肝移植（LT）。然而，对于巨脾的患者，即使在 LT 后，脾肿大和脾功能亢进仍可能持续存在。
探讨在晚期肝硬化合并严重脾肿大和脾功能亢进患者中行 LT 时行部分脾切除术的可行性。
2015 年 10 月至 2019 年 2 月，天津第一中心医院对 762 例终末期肝病患者进行了原位 LT。84 例患者患有晚期肝硬化合并严重脾肿大和脾功能亢进。其中 41 例患者在 LT 时行部分脾切除术（PSLT 组），43 例仅行 LT（LT 组）。回顾性分析比较两组患者的一般资料、术中参数及术后转归。
PSLT 组术后脾功能亢进（2/41，4.8%）和复发性腹水（1/41，2.4%）的发生率明显低于 LT 组（22/43，51.2%；8/43，18.6%）。LT 组 17 例（17/43，39.5%）患者需要行两阶段脾动脉栓塞术，其中 6 例进一步行脾切除术。PSLT 组的手术时间和术中出血量（8.6±1.3 h；640.8±347.3 mL）较 LT 组（6.8±0.9 h；349.4±116.1 mL）相对增加。PSLT 组术后出血、肺部感染、血栓形成和脾动脉盗血综合征的发生率与 LT 组无差异。
同期行 PSLT 是一种有效的治疗方法，对于晚期肝硬化合并严重脾肿大和脾功能亢进的患者，应行同期 PSLT，以预防术后持续性脾功能亢进。
