The role of spontaneous portal-systemic shunts in liver transplantation: case report and literature review.
The role of spontaneous portal-systemic shunts in liver transplantation: case report and literature review.
复制标题
自发性门体分流术在肝移植中的作用：病例报告和文献综述。
DOI：
10.21037/apm-20-2431
复制
发表时间：
2021
影响因子：
--
通讯作者：
Xiaoshun He
中科院分区：
文献类型：
--
作者：
Tielong Wang;Jinlong Gong;Zhitao Chen;Changjun Huang;Jia Yu;Zhiyong Guo;Xiaoshun He
我们描述了针对终末期肝病和自发性门体分流（SPSS）患者的两次肝移植。我们在第一个病例中结扎了脾肾分流器（SRS），但在第二个病例中没有结扎。术后检查发现两例门脉血流速度、血氨水平、肝功能及预后存在显着差异。第一个病例门脉血流充足，血氨下降，移植肝功能立即恢复。第二例术后门静脉血流不足，血氨水平未明显降低，可能是由于术后SRS仍然存在。第一例患者术后恢复良好，顺利出院，而第二例患者术后出现早期同种异体移植功能障碍（EAD），并于术后第 18 天死于肺部感染。肝移植（LT）中 SPSS 的正确管理非常重要，因为它会影响肝移植的功能和患者预后，因此我们回顾了相关文献，列出了不同类型的 SPSS 及其临床特征。推荐直径大于8mm的SPSS在LT时结扎非小尺寸移植物，以保证足够的门静脉血流，并保留小尺寸肝移植物，以避免门静脉过度输血和门静脉高压，除非门静脉血流明显不足。
We described two liver transplants for patients with end-stage liver disease and spontaneous portal-systemic shunt (SPSS). We ligated the splenorenal shunt (SRS) in the first case but did not ligate it in the second case. Postoperative examination revealed significant differences in portal blood flow velocity, serum ammonia level, liver function and prognosis between two cases. The portal blood flow in the first case was sufficient with decreased serum ammonia and immediate liver graft function. The portal blood flow was insufficient and serum ammonia level was not significantly reduced after operation in the second case probably because SRS was still present after surgery. The first case recovered well after operation and was discharged uneventfully, however, the second patient suffered early allograft dysfunction (EAD) after operation and died of pulmonary infection on postoperative day (POD) 18. Proper management of SPSS in liver transplantation (LT) is important because it can affect the function of liver graft and patient prognosis, so we reviewed the relevant literature and list different types of SPSS and their clinical characteristics. We recommend that SPSS greater than 8 mm in diameter should be ligated in LT with non-small size graft to ensure adequate portal flow and preserved with small size liver graft to avoid portal hypertransfusion and portal hypertension except obviously insufficient portal blood flow.