Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, 100050, China.
Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, 100050, China; Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Int J Surg. 2021 Apr;88:105926. doi: 10.1016/j.ijsu.2021.105926. Epub 2021 Mar 18.
Simultaneous splenectomy during liver transplantation is indicated for patients with cirrhosis complicated by severe hypersplenism, but disastrous procedure-related complications remain a special concern. Simultaneous partial splenectomy was adopted in pediatric liver transplant recipients with severe hypersplenism-related pancytopenia at our institution.
A prospective, single-center analysis of 21 pediatric patients diagnosed with cirrhosis and severe hypersplenism, who underwent liver transplantation between January 2015 to December 2019, was conducted. Patient characteristics, intraoperative parameters, and postoperative outcomes were compared between patients with simultaneous partial splenectomy (n = 13) and those without (n = 8).
Simultaneous partial splenectomy significantly increased platelet and leukocyte counts in the early postoperative period, without increasing operative time, intraoperative blood loss and postoperative hospital stay (P = 0.64, P = 0.44, P = 0.26, respectively). No significant differences were observed between the two groups regarding the incidence of postoperative hemorrhage (P = 0.38), pneumonia (P = 0.33), cholangitis (P = 0.38), thrombotic complications (P = 1.00), cytomegalovirus infection (P = 0.53), Epstein-Barr virus infection (P = 0.20) and acute rejection (P = 0.26).
Simultaneous partial splenectomy during liver transplantation could serve as a feasible alternative to splenectomy in selected patients with severe hypersplenism, which can achieve a satisfactory long-term hematological response, but avoid untoward complications of splenectomy.
在肝移植中同时进行脾切除术适用于伴有严重脾功能亢进的肝硬化患者，但灾难性的与手术相关的并发症仍然是一个特殊的关注点。本中心在接受肝移植的严重脾功能亢进相关全血细胞减少症的儿科患者中采用了同时部分脾切除术。
对 2015 年 1 月至 2019 年 12 月期间诊断为肝硬化和严重脾功能亢进并接受肝移植的 21 例儿科患者进行了前瞻性、单中心分析。比较了同时行部分脾切除术（n=13）和未行脾切除术（n=8）患者的患者特征、术中参数和术后结局。
同时行部分脾切除术可显著增加术后早期血小板和白细胞计数，而不增加手术时间、术中出血量和术后住院时间（P=0.64、P=0.44、P=0.26）。两组患者术后出血（P=0.38）、肺炎（P=0.33）、胆管炎（P=0.38）、血栓并发症（P=1.00）、巨细胞病毒感染（P=0.53）、EB 病毒感染（P=0.20）和急性排斥反应（P=0.26）的发生率无显著差异。
在肝移植中同时行部分脾切除术可以作为严重脾功能亢进患者脾切除术的一种可行替代方法，可获得满意的长期血液学反应，但避免了脾切除术的不良并发症。
