肝移植术中脾肾分流的个体化处理  

Individualized treatment of splenorenal shunt during liver transplantation

作　　者：程道柔 杨卿[1] 张英才[1] 王励[1] 谌小龙[1] 李慧[1] 杨扬[1] 陈规划[1] 汪根树[1] Cheng Daorou;Yang Qing;Zhang Yingcai;Wang Li;Chen Xiaolong;Li Hui;Yang Yang;Chen Guihua;Wang Genshu(Department of Hepatic Surgery,Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University,Key Laboratory of Liver Disease Research of Guangdong Province,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心广东省肝脏疾病研究重点实验室

出　　处：《器官移植》2019年第4期443-448,共6页Organ Transplantation

基　　金：广东省科技计划项目(2017B020209004)

摘　　要：目的评估肝移植术中个体化处理脾肾分流的安全性和有效性。方法回顾性分析2例行原位肝移植并术中处理脾肾分离的受者临床资料,根据脾肾分流和供肝复流后灌注情况,2例受者术中分别行左肾静脉结扎术和脾肾分流血管结扎术。观察受者的术后一般情况,包括手术相关并发症、门静脉血流峰值速度、肝功能和肾功能指标。通过腹部超声监测受者术后情况。结果2例受者术中及术后均未出现手术相关并发症。病例1和病例2脾肾分流前后门静脉血流峰值速度的变化分别为22.9~35.1cm/s、24.3~58.8cm/s。2例受者术后丙氨酸转氨酶(ALT)未出现延迟恢复。病例1受者术后出现一过性血清肌酐(Scr)升高,于术后13d恢复正常。术后随访过程中,超声检查显示门静脉血流方向和速度正常,肝脏灌注良好。结论肝移植术中对合并严重脾肾分流的受者选择性结扎其左肾静脉或脾肾分流血管是安全和有效的。Objective To evaluate the safety and efficacy of individualized treatment of splenorenal shunt during liver transplantation. Methods Clinical data of 2 recipients who underwent orthotopic liver transplantation and splenorenal shunt intraoperatively were retrospectively analyzed. According to the perfusion status after splenorenal shunt and donor liver reflow, the left renal vein ligation and splenorenal shunt vessel ligation were performed in two recipients during liver transplantation. The general postoperative conditions of the recipients were observed, including surgical related complications, peak portal blood flow velocity, liver and renal function indexs. The postoperative conditions of the recipients were monitored by abdominal ultrasound. Results No intraoperative or postoperative complications occurred in two recipients. The changes of peak portal blood flow velocity before and after splenorenal shunt in two recipients were 22.9-35.1 cm/s and 24.3-58.8 cm/s respectively. No delayed recovery of alanine aminotransferase (ALT) level was observed in two patients after operation. Case 1 experienced a transient increase in the serum creatinine (Scr), which was recovered to normal at postoperative 13 d. During the postoperative follow-up, ultrasound examination demonstrated that the direction and velocity of portal blood flow were normal and liver perfusion was excellent. Conclusions It is safe and effective to selectively ligate the left renal vein or splenorenal shunt vessels of the recipients with severe splenorenal shunt during liver transplantation.

关 键 词：脾肾分流 肝移植 左肾静脉结扎术 脾肾分流血管结扎术 个体化处理 

分 类 号：R617[医药卫生—外科学]