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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

梁莹莹 颜荣华 王劲 刘静静 任泠斓 胡冰 何炳均 姜在波 单鸿

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
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

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

doi: 10.3969/j.issn.1674-7445.2014.01.005
基金项目: 

广东省医学科研基金 B2012196

详细信息
    通讯作者:

    王劲,Email:wangjin21cn@163.com

  • 中图分类号: R617

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

  • 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。

     

  • 图  1  C组部分乙肝后肝硬化并肝癌患者肝移植术后腹部CT与MRI变化

    注:A、B图为1例33岁男性患者;A图为肝移植术前CT图像,脾静脉管径增粗(白色粗箭头),胃底静脉曲张(白色细箭头);B图为肝移植术后3个月MRI图像,脾脏体积仍增大,脾静脉管径仍增粗(白色粗箭头),胃底静脉曲张(白色细箭头)。C~E图为1例32岁男性患者;C图为肝移植术前CT图像,显示脾大;D、E图分别为肝移植术后3个月、8个月CT图像,可见脾脏体积进行性增大,门静脉左支癌栓形成(E图白色箭头)。F~H图为1例44岁男性患者;F图为肝移植术前MRI图像;G、H图为肝移植术5个月后随访CT及其重建MIP图像,示脾脏体积增大,肝中、肝左静脉合干根部重度狭窄伴血栓形成(G、H图白色箭头),肝右静脉纤细(G图黑色箭头)

    Figure  1.  Changes of abdominal CT and MRI images of patients with hepatic cirrhosis after hepatitis B combined with hepatocellular carcinoma in group C before and after liver transplantation

    表  1  3组肝移植患者手术前后脾脏的形态学指标及脾静脉、门静脉直径变化

    Table  1.   Change of morphological indicators and diameters of splenic and portal vein of patients in three groups before and after liver transplantation(x±s)

    组别 n 脾脏 门静脉直径(cm) 脾静脉直径(cm)
    宽度(cm)厚度(cm)长径(cm)体积(cm3)
    A组
    术前1810.81±1.75a4.2±0.7a11.6±2.0a344±125a1.23±0.30a0.89±0.28
    术后189.48±1.09a,b3.3±0.4a,c10.3±1.7a,b219±28a,c1.07±0.23a 0.83±0.24
    B组
    术前3913.85±2.55a5.0±1.0a15.0±3.5a668±358a1.33±0.24a1.02±0.27
    术后3912.39±2.00a,c4.4±1.0a,c13.5±3.2a,b492±228a,c1.27±0.20a 0.95±0.17
    C组
    术前1711.15±2.04a4.0±0.7a11.5±2.3a330±112a1.24±0.19a0.89±0.19
    术后1712.54±1.84a4.4±1.0a13.5±3.2a492±228a,b1.27±0.20a0.95±0.17
    正常对照组207.93±1.523.8±0.89.3±1.3185±710.97±0.110.65±0.13
    注:与正常对照组比较,aP<0.01;与同组术前比较,bP<0.05,cP<0.01
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出版历程
  • 收稿日期:  2013-11-16
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2014-01-15

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