梁莹莹, 颜荣华, 王劲, 等. 肝硬化肝移植术后脾脏体积及侧支循环状态对胆道并发症的影响[J]. 器官移植, 2014, 5(1): 18-23. DOI: 10.3969/j.issn.1674-7445.2014.01.005
引用本文: 梁莹莹, 颜荣华, 王劲, 等. 肝硬化肝移植术后脾脏体积及侧支循环状态对胆道并发症的影响[J]. 器官移植, 2014, 5(1): 18-23. DOI: 10.3969/j.issn.1674-7445.2014.01.005
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Liang Yingying, Yan Ronghua, Wang Jin, et al. Impacts of spleen volume and collateral circulation on the biliary complications in patients with hepatic cirrhosis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(1): 18-23. DOI: 10.3969/j.issn.1674-7445.2014.01.005
Citation: Liang Yingying, Yan Ronghua, Wang Jin, et al. Impacts of spleen volume and collateral circulation on the biliary complications in patients with hepatic cirrhosis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(1): 18-23. DOI: 10.3969/j.issn.1674-7445.2014.01.005
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肝硬化肝移植术后脾脏体积及侧支循环状态对胆道并发症的影响

Impacts of spleen volume and collateral circulation on the biliary complications in patients with hepatic cirrhosis after liver transplantation

    摘要
  • 摘要:
      目的   探讨终末期肝硬化患者肝移植术后脾脏体积及侧支循环状态对术后胆道并发症的影响。
      方 法   选取2005年4月至2013年2月在中山大学附属第三医院接受肝移植手术的74例患者,肝移植术前、后均行计算机体层摄影术(CT)和(或)磁共振成像(MRI)检查。根据肝移植术后脾脏体积的变化将74例患者分为3组:体积缩小至接近正常范围组(A组),体积缩小仍超出正常范围组(B组)和体积增大组(C组)。同时选取20名健康人作为正常对照组。分别统计3组患者术前与术后脾脏形态及脾静脉、门静脉直径变化的数据,并与正常对照组进行比较。记录3组患者术前与术后侧支循环开放情况及术后随访情况。
      结果   A组18例(24%),B组39例(53%)和C组17例(23%)。A组、B组术后侧支循环得到明显缓解,C组术后侧支循环不但未见缓解,反而较前加重。A组6例(33%)患者肝移植术后出现轻度血管并发症,1例(6%)患者肝移植术后出现轻度缺血性胆管炎。B组17例(44%)患者肝移植术后出现轻度血管并发症,6例(15%)患者出现轻度缺血性胆管炎。C组17例(100%)患者肝移植术后出现严重血管并发症,同时均伴有不同程度的胆道并发症,5例患者肝门区发现肉芽组织形成。
      结论   终末期肝硬化患者肝移植术后胆道并发症发生率较高,肝移植术后严重的血管并发症导致的血流动力学异常是其影响因素之一。

     

    Abstract:
      Objective   To investigate the impacts of spleen volume and collateral circulation on the biliary complications in patients with end-stage hepatic cirrhosis after liver transplantation(LT).
      Method   Seventy-four patients who underwent LT in the Third Affiliated Hospital of Sun Yat-sen University from April 2005 to February 2013 were enrolled in this study. All the patients received computed tomography (CT) and/or magnetic resonance imaging (MRI) before and after LT. The patients were divided into 3 groups according to the changes of spleen volume after LT: group A (the volume reduced to the normal range), group B (the volume reduced but still exceeded the normal range), group C (the volume increased). Twenty healthy people were enrolled in the study as the normal control group. The spleen form and diameter changes of splenic vein, portal vein before and after operation in 3 groups were counted and compared with that in normal control group. The establishment of collateral circulation before and after operation and postoperative follow-up of patients in 3 groups were recorded.
      Result   There were 18 cases(24%) in group A, 39 cases (53%) in group B, 17 cases(23%)in group C. The collateral circulation was obviously relieved after operation for patients in group A and group B, but it was not relieved and became worse for patients in group C. Six cases (33%) in group A suffered from mild vascular complications after LT and 1 case (6%) suffered from mild ischemic cholangitis after LT. Seventeen cases (44%) in group B suffered from mild vascular complications after LT and 6 cases(15%) suffered from mild ischemic cholangitis after LT. Seventeen cases (100%) in group C suffered from severe vascular complications after LT with biliary complications of different degrees and granulation tissues were found in hepatic hilar area of 5 cases.
      Conclusion   The incidence of biliary complications in patients with end stage hepatic cirrhosis and portal hypertension after LT is comparatively high. The abnormal hemodynamics caused by severe vascular complications after LT is one of the influences.

     

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