肝移植术围手术期脾亢处理研究论文

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1、肝移植术围手术期脾亢处理研究论文第7页共7页肝移植术围手术期脾亢处理研究论文第7页共7页肝移植术围手术期脾亢处理研究论文第7页共7页肝移植术围手术期脾亢处理研究论文第7页共7页肝移植术围手术期脾亢处理研究论文第7页共7页肝移植术围手术期脾亢处理研究论文第7页共7页【关键词】肝移植；脾功能亢进；移植物排斥；血小板；肺部感染Treatmentofhypersplenisminperioperationoflivertransplantation【Abstract】AIM:Toobservethechangesinhypersplenismafterorthotopiclivertransplan

2、tation(OLT)andtoinvestigatetheinfluenceofsplenectomyorsplenicarteryligationbeforeorduringlivertransplantationonthetherapeuticoutcome.METHODS:Splenectomyorsplenicarteryligationwasperformedon15(groupA)oftheconsecutive115patientsundergoingOLTin5years,beforeOTCin11ofthemandduringOTCin4ofthem.Sixtyeight

3、randomlyselectedagematchedpatientsundergoingOTCwithinthesameperiodbutwithoutsplenectomyorsplenicarteryligationwereusedascontrols(groupB).Acuterejectionrate,bloodPLTcount,incidenceoflunginfectionandPVF/HAF（portalvenousflow/hepaticarterialflow）werecalculatedandanalyzed.RESULTS:Lunginfactionrateofgrou

4、pAwas85%,significantlyhigherthanthatofgroupB(54%,P<0.05);acuterejectiondidnotoccuringroupA,butin10casesofgroupB(15%),however,withoutsignificantdifferencesbetweenthem;bloodPLTpeaklevelofgroupAwas(340±158)×109/L,significantlyhigherthanthatofgroupB［(249±93)×109/L,P<0.01］;bloodPLTcountreachedthepeaklev

5、el25daftertheoperationingroupA,and21dingroupB;nosignificantdifferencebetweenthem;PVF/PAFwas12±8ingroupA，significantlylowerthangroupB(24±16,P<0.05).CONCLUSION:Splenectomyshouldbeperformedcautiouslyforhypersplenismbasedontheoperativeindications.Spleenarteryligationorembolizationisbeneficialtotheprogn

6、osisofthepatientswithseverethrombocytopenia,arterialstealsyndromeorexcessiveportalveininfusion.【Keywords】livertransplantation;hypersplenism;graftrejection;bloodplatelets;pulmonaryinfection【摘要】目的：观察原位肝移植术后脾功能亢进(脾亢)的变化，探讨脾亢患者肝移植的处理方法.方法：回顾分析5年内我院115例接受肝移植手术、符合入选条件的脾脏切除或脾动脉结扎患者,将15例作为实验组(A组)，其中11例在术前、

7、4例在术中行脾脏切除术或脾动脉结扎术；将68例年龄匹配的同期未切脾肝移植受体随机选为对照组（B组）.分析术后急性排斥反应发生率、血小板计数、肺部感染发生率以及移植肝门静脉肝动脉血流量比（PVF/HAF）的变化规律.结果：急性排斥反应发生率在A组为0，B组为15%，B组明显升高但与A组相比无显著性差异；术后A组肺部感染率为85%，显著高于B组的54%（P<0.05）；A组的血小板峰值为（340±158）×109