Samimi F, Irish W D, Eghtesad B, Demetris A J, Starzl T E, Fung J J
Thomas E. Starzl Transplant Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Dig Dis Sci. 1998 Sep;43(9):1931-7. doi: 10.1023/a:1018822206580.
Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenectomy within the same time period. One-year patient and graft survival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized (non-Splx) patients (59% vs 86% PS, 55% vs 80% GS, respectively). One-month and one-year patient mortality in the Splx group was higher than in the non-splx patients (20% vs 3.4%, P < 0.001 for one month; 40% vs 14.3%, P = 0.003 for one year, respectively). One-month and one-year sepsis-related mortality was also high in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043, for one year, respectively). We conclude that concomitant splenectomy with OLTx has a significantly higher patient mortality mainly due to its septic complications and, at present, unless there is a specific indication for a splenectomy, the routine addition of this procedure to liver allograft surgery would not be recommended.
1987年1月至1991年10月期间，1466例患者在匹兹堡大学接受了连续原位肝移植（OLTx）。其中40例患者在接受OLTx的同时进行了脾切除术。将这些患者与同期随机选取的147例未进行脾切除术的OLTx患者进行比较。脾切除（Splx）患者的1年患者和移植物存活率（PS和GS）低于未进行脾切除（非Splx）的患者（PS分别为59% vs 86%，GS分别为55% vs 80%）。Splx组的1个月和1年患者死亡率高于非Splx患者（1个月时为20% vs 3.4%，P < 0.001；1年时为40% vs 14.3%，P = 0.003）。Splx患者的1个月和1年脓毒症相关死亡率也较高（1个月时为17.5% vs 2.7%，P = 0.0022；1年时为30% vs 11.5%，P = 0.0043）。我们得出结论，OLTx同时进行脾切除术会使患者死亡率显著升高，主要是由于其感染性并发症，目前，除非有脾切除的特定指征，否则不建议在肝移植手术中常规增加此手术。
