中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

脾动脉盗血综合征:一个被忽视的肝病治疗靶点

刘全达 宋扬 周宁新

引用本文:
Citation:

脾动脉盗血综合征:一个被忽视的肝病治疗靶点

基金项目: 

北京市首都临床特色应用研究重点项目(D101100050010042); 中国博士后科学基金(20080441275); 

详细信息
  • 中图分类号: R657.3

Splenic arterial steal syndrome:a neglected therapeutic target for liver diseases

Research funding: 

 

  • 摘要: 肝脏对动脉低灌注所致的缺氧非常敏感,这在肝移植术后移植物并发症(如肝动脉血栓形成、动脉瘤)中已经得到证实,可导致严重的胆道缺血性损害、移植物失功能、甚至受体死亡等严重并发症。脾动脉盗血综合征(SASS)是肝移植术后一种较少认识的动脉并发症。SASS本质是粗大的脾动脉"盗走"肝动脉血流而导致肝动脉灌注不良;不及时干预,SASS亦可导致严重的移植物并发症。目前临床上尚未形成"肝硬化性SASS"概念,更未认识其危害性。肝硬化性SASS是慢性肝病损害的结果,并加重肝损害的病理过程,临床上无特异性,多表现为基础肝病合并脾脏肿大等异常。我们通过三维CT血管成像及血管造影证实失代偿期肝硬化患者普遍存在SASS,并证实纠正SASS后肝硬化患者的肝功能指标、Child-Pugh评分、评级等显著改善,并降低了消化道出血风险。因此,该文在国际上首次提出了肝硬化性SASS概念,并证实SASS是失代偿期肝硬化患者改善肝功能的一个有效治疗靶点,可作为等待肝移植的架桥性治疗措施。

     

  • [1]Sanyal R, Shah SN.Role of Imaging in the management of splenic artery steal syndrome[J].J Ultrasound Med, 2009, 28 (4) :471-477.
    [2]Mogl MT, Nussler NC, Presser SJ, et al.Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation[J].Transplant Int, 2010, 23 (8) :831-841.
    [3]Uflacker R, Selby JB, Chavin K, et al.Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation[J].Cardiovasc Intervent Radiol, 2002, 25 (4) :300-306.
    [4]Nussler NC, Settmacher U, Haase R, et al.Diagnosis and treatment of arterial steal syndromes in liver transplant recipients[J].Liver Transpl, 2003, 9 (6) :596-602.
    [5]刘全达, 周宁新, 王茂强, 等.肝脏移植术后脾动脉盗血综合征的诊治[J].消化外科, 2004, 3 (4) :232-234.
    [6]刘全达, 周宁新.重视肝移植术后肝动脉并发症的防治[J].局解手术学杂志, 2004, 13 (3) :封2.
    [7]刘全达, 周宁新, 王茂强, 等.肝移植术后脾动脉盗血综合征[J].中华外科杂志, 2005, 43 (15) :989-990.
    [8]Quintini C, Hirose K, Hashimoto K, et al."Splenic artery steal syndrome"is a misnomer:the cause is portal hyperperfusion, not arterial siphon[J].Liver Transpl, 2008, 14 (3) :374-379.
    [9]Humar A, Beissel J, Crotteau S, et al.Delayed splenic artery occlusion for treatment of established small-for-size syndrome after partial liver transplantation[J].Liver Transpl, 2009, 15 (2) :163-168.
    [10]Rodriguez-Roisin R, Krowka MJ.Hepatopulmonary syndrome-A liver-induced lung vascular disorder[J].N Engl J Med, 2008, 358 (22) :2378-2387.
    [11]Kodama T, Takehara T, Hikita H, et al.Thrombocytopenia exacerbates cholestasis-induced liver fibrosis in mice[J].Gastroenterology, 2010, 138 (7) :2487-2498.
    [12]Kim J, Yi NJ, Shin WY, et al.Platelet transfusion can be related to liver regeneration after living donor liver transplantation[J].World J Surg, 2010, 34 (5) :1052-1058.
    [13]Alkozai EM, Nijsten MW, de Jong KP, et al.Immediate postoperative low platelet count is associated with delayed liver function recovery after partial liver resection[J].Ann Surg, 2010, 251 (2) :300-306.
    [14]Liu Q, Ma K, Song Y, et al.Two-year follow-up of radiofrequency ablation for patients with cirrhotic hypersplenism:Does increased hepatic arterial flow induce liver regeneration?[J].Surgery, 2008, 143 (4) :509-518.
    [15]Liu Q, Ma K, He Z, et al.Radiofrequency ablation for hypersplenism in patients with liver cirrhosis:a pilot study[J].J Gastrointest Surg, 2005, 9 (5) :648-657.
  • 加载中
计量
  • 文章访问数:  248
  • HTML全文浏览量:  20
  • PDF下载量:  140
  • 被引次数: 0
出版历程
  • 出版日期:  2011-03-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回