肝移植术后脾动脉盗血综合征不同方法介入治疗的回顾性分析  

A retrospective study on the different methods of interventional therapy for splenic artery steal syndrome after liver transplantation

作　　者：伊正甲 陈光[1] 高海军[1] 王浩[1] Yi Zhengjia;Chen Guang;Gao Haijun;Wang Hao(Radiology Department,First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院放射科,天津300192

出　　处：《中华肝胆外科杂志》2018年第9期581-584,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨超声造影检查诊断肝移植术后脾动脉盗血综合征（SASS）的可行性，比较不同栓塞方式治疗脾动脉盗血综合征的疗效及安全性。方法2005年1月一2017年12月，在我院接受肝移植患者中有41例术后出现SASS。本院所有患者移植术后均行超声及超声造影检查，其中19例患者超声造影提示存在SASS，后经血管造影确诊。所有患者均行脾动脉栓塞术，其中单纯应用弹簧圈栓塞者32例（A组），使用Amplatzer封堵器辅助栓塞者9例（B组）。结果41例SASS患者，经脾动脉栓塞术后，血管造影均显示肝内2、3级动脉分支较治疗前数目增多，管径增加，血流充盈良好，术后超声血流及频谱恢复正常。A组术后出现脾梗死12例（12／32，37．5％），其中脾部分梗死11例，脾完全梗死继发脾脓肿1例；B组术后出现脾部分梗死2例（2／9，22．2％）。脾部分梗死患者均无临床症状，无需治疗。1例脾完全梗死继发脾脓肿患者后行抗感染及脾脓肿穿刺引流治疗后好转。除脾梗死外未见其他介入治疗相关并发症。结论超声造影检查有助于肝移植术后脾动脉盗血的早期诊断，而脾动脉介入栓塞则是治疗肝移植术后脾动脉盗血综合征最为安全、有效的方法。使用Amplatzer封堵器辅助栓塞治疗较传统单纯螺圈栓塞具有栓塞位置准确、并发症少等优势。Objective To study the use of contrast-enhanced ultrasound in diagnosing splenic arterial steal syndrome （SASS） after liver transplantation, and to compare the curative effect, safety and follow- up results of the different embolization methods in the treatment of SASS after liver transplantation. Methods From January 2005 to December 2017, 41 patients after liver transplantation in our hospital developed splenic artery steal syndrome and were treated with splenic arterial embolization. All these patients underwent ul- trasound, and in 19 patients contrast- enhanced uhrasonography was also done to detect the presence of splenic artery steal. The findings were confirmed by angiography. These patients then underwent splenic arterial embolization. In 32 patients coil embolization was done （group A） and in 9 patients embolization was assisted with Amplatzer occluders （group B）. Results In all the 41 patients with SASS, angiography after splenic artery embolization showed the second and third order arterial branches in the liver increased in number and in diameter with good blood flow compared with those before treatment. The postoperative blood flow and pattern on ultrasound returned to normal. In group A, 12 patients （12/32, 37.5%） developed splenic infarction, including 11 patients with partial splenic infarction, and 1 patient developed a splenic abscess af- ter complete splenic infarction. In group B, two patients developed partial splenic infarction （2/9, 22.2% ）. All the patients with splenic infarct had no clinical symptoms. No treatment was required except for the patient who developed splenic abscess after complete splenic infarction. The patient recovered well after treatment with antibiotics and splenic abscess drainage. There was no other complications. Conclusions Contrast-enhanced ultrasound provided early diagnosis of splenic artery steal after liver transplantation. Interventional splenic artery embolization was safe and effective to treat splenic arterial steal syndrome after live

关 键 词：肝移植 脾动脉盗血综合征 超声造影检查 介入栓塞治疗 脾动脉栓塞 

分 类 号：R657.3[医药卫生—外科学] R445.1[医药卫生—临床医学]