Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism  

作　　者：Wen-Tao Jiang Jian Yang Yan Xie Qing-Jun Guo Da-Zhi Tian Jun-Jie Li Zhong-Yang Shen 

机构地区：[1]Department of Liver Transplantation,Tianjin First Center Hospital,First Clinical Institute of Tianjin Medical University,Tianjin 300192,China [2]Organ Transplantation Center,Tianjin First Center Hospital,Tianjin 300192,China [3]Department of Hepatological Surgery,Zibo Central Hospital,Zibo 255000,Shandong Province,China

出　　处：《World Journal of Gastroenterology》2021年第7期654-665,共12页世界胃肠病学杂志（英文版）

基　　金：National Natural Science Foundation of China,No.81870444;Tianjin Natural Science Foundation,No.19JCQNJC10300;Spring Bud Plan of Tianjin First Central Hospital,No.TFCHCL201801.

摘　　要：BACKGROUND The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation(LT).However,splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.AIM To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.METHODS Between October 2015 and February 2019,762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital.Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism.Among these patients,41 received partial splenectomy during LT(PSLT group),and 43 received only LT(LT group).Patient characteristics,intraoperative parameters,and postoperative outcomes were retrospectively analyzed and compared between the two groups.RESULTS The incidence of postoperative hypersplenism(2/41,4.8%)and recurrent ascites(1/41,2.4%)in the PSLT group was significantly lower than that in the LT group(22/43,51.2%;8/43,18.6%,respectively).Seventeen patients(17/43,39.5%)in the LT group required two-stage splenic embolization,and further splenectomy was required in 6 of them.The operation time and intraoperative blood loss in the PSLT group(8.6±1.3 h;640.8±347.3 mL)were relatively increased compared with the LT group(6.8±0.9 h;349.4±116.1 mL).The incidence of postoperative bleeding,pulmonary infection,thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group,respectively.CONCLUSION Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.

关 键 词：Liver transplantation Partial splenectomy HYPERSPLENISM SPLENOMEGALY Liver cirrhotic Megalosplenia 

分 类 号：R657.3[医药卫生—外科学] R657.6[医药卫生—临床医学]