Splenic arterial steal syndrome:a neglected therapeutic target for liver diseases
-
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。Abstract: The liver is extremely susceptible to ischemia resulting from arterial hypoperfusion, which is confirmed by the graft arterial complications (such as hepatic artery thrombosis, aneurysm) after liver transplantation.Arterial hypoperfusion may lead to severe complications, e.g.ischemic biliary destruction, graft loss, even recipient death.Splenic arterial steal syndrome (SASS) is a seldom-recognized arterial complication following liver transplantation.SASS describes the phenomenon of poor arterial perfusion of hepatic parenchyma due to "stealing" or diverting of blood from the hepatic artery to the dilated splenic artery.SASS also can cause severe graft morbidity if it is not managed timely.However, there still has no clear concept of SASS in cirrhosis, moreover, the clinicians have not realized its risks to liver dysfunction.Cirrhotic SASS is a consequence of chronic liver disease, and conversely aggravates the liver damage.The clinical manifestation of cirrhotic SASS is not special, and mostly accompanied with abnormalities of poor liver function caused by underlying liver diseases and splenomegaly.We have confirmed the prevalence of SASS in patients with decompensated cirrhosis by 3-dimensional CT angiography and celiac angiography, and also have demonstrated that the liver function, Child-Pugh score and classification of cirrhotic patients can be improved after correction of SASS, as well as reducing the risks of gastrointestinal bleeding.In conclusion, this article firstly proposed the concept of cirrhotic SASS, and confirmed that SASS is an efficacious therapeutic target for improvement of liver function in patients with decompensated cirrhosis, which can be a bridging therapy for patients awaiting liver transplantation.
-
Key words:
- liver cirrhosis /
- liver transplantation /
- splenic arterial steal syndrome
-
[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.
本文二维码
计量
- 文章访问数: 361
- HTML全文浏览量: 20
- PDF下载量: 145
- 被引次数: 0