门静脉高压症患者行断流术和分流术对肝移植的影响  

Effect of devascularization and shunt on liver transplantation in patients with portal hypertension

作　　者：孟炜[1] 赵辉[1] 张彤[1] 傅斌生[1] 汪国营[1] 易述红[1] 许赤[1] 汪根树[1] 李华[1] 杨扬[1,2,3] 陈规划[1,2,3] 

机构地区：[1]中山大学附属第三医院器官移植中心,广州510630 [2]广东省肝脏病研究重点实验室 [3]肝脏疾病生物治疗临床转化广东普通高校重点实验室

出　　处：《器官移植》2016年第5期378-381,共4页Organ Transplantation

基　　金：国家自然科学基金(81170451、81172038、81372243、81370575、81370555);广东省自然科学基金(S20120011190);广州市科技重大专项(201400000001-3)

摘　　要：目的探讨门静脉高压症患者行断流术及分流术对其行肝移植的影响。方法回顾性分析2007年1月至2011年12月中山大学附属第三医院器官移植中心收治的182例肝硬化、门静脉高压症伴食道胃底静脉曲张出血史的肝移植患者的临床资料。将肝移植前行脾切除+贲门周围血管离断术19例设为断流术组,行远端脾-肾静脉分流术5例设为分流术组,其余无断流或分流手术史的158例作为对照组。比较3组受者在肝移植术前门静脉血栓形成发生率、手术时间、术中出血量、术后1个月门静脉吻合口最大血流速度(V_(max))、术后门静脉血栓形成发生率及3年存活率等方面的差异。结果断流术组受者术前门静脉血栓形成的发生率明显高于对照组(P<0.01)。与对照组比较,断流术组、分流术组的肝移植手术时间均明显增加(均为P<0.05),断流术组术后1个月门静脉血栓形成的发生率明显升高(P<0.05)。断流术组、分流术组的3年存活率明显降低(均为P<0.05)。3组受者的术中出血量及术后1个月门静脉吻合口V_(max)比较差异均无统计学意义(均为P>0.05)。结论门静脉高压症患者既往接受的断流术或分流术不会给后续的肝移植造成严重的困难或风险。Objective To evaluate the influence of devascularization and shunt on liver transplantation in patients diagnosed with portal hypertension. Methods Clinical data of 182 patients diagnosed with cirrhosis,portal hypertension complicated with hemorrhages caused by esophageal and gastric varices rupture undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from January 2007 to December 201 1 were retrospectively analyzed. Nineteen patients undergoing splenectomy plus pericardial devascularization were assigned into the devascularization group,5 receiving distal spleen-renal vein shunt into the shunt group,and the remaining 158 cases with no history of devascularization or shunt into the control group. Preoperative incidence of pylethrombosis,operation time,intraoperative hemorrhage volume,the maximal blood flow velocity （Vmax ）of portal vein anastomotic stoma at postoperative 1 month,postoperative incidence of pylethrombosis and 3-year survival rate were statistically compared among three groups. Results In the devascularization group,preoperative incidence of pylethrombosis was significantly higher compared with that in the control group（P〈0.01）.Compared with the control group,operation time of liver transplantation in the devascularization and shunt groups was significantly longer （both P〈0.05 ）. The incidence of pylethrombosis at postoperative 1 month was considerably enhanced in the devascularization group （P 〈0.05 ）. The 3-year survival rates of devascularization group and shunt group were dramatically decreased compared with that of control group （both P〈0.05 ）. Intraoperative hemorrhage volume and Vmax of＆amp;nbsp;portal vein anastomotic stoma did not significantly differ among three groups （all P〉0.05 ）. Conclusions The medical history of devascularization or shunt will not cause severe difficulty or surgical risk to subsequent liver transplantation in patients with portal hypertension.

关 键 词：肝移植 门静脉高压症 断流术 分流术 

分 类 号：R617[医药卫生—外科学] R657.3[医药卫生—临床医学]