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タイトル(別表記)
Splenic artery syndrome after living donor liver transplantation with ligation of the splenic artery : A case report
著者
佐藤 太祐 岡山大学大学院医歯薬学総合研究科 消化器外科学
八木 孝仁 岡山大学大学院医歯薬学総合研究科 消化器外科学
貞森 裕 岡山大学大学院医歯薬学総合研究科 消化器外科学
松田 浩明 岡山大学大学院医歯薬学総合研究科 消化器外科学
篠浦 先 岡山大学大学院医歯薬学総合研究科 消化器外科学
楳田 祐三 岡山大学大学院医歯薬学総合研究科 消化器外科学
吉田 龍一 岡山大学大学院医歯薬学総合研究科 消化器外科学
内海 方嗣 岡山大学大学院医歯薬学総合研究科 消化器外科学
藤原 俊義 岡山大学大学院医歯薬学総合研究科 消化器外科学
抄録
After orthotopic liver transplantation, splenic artery syndrome (SAS), a phenomenon by which the main blood flow of the impaired hepatic artery is shifted to the splenic artery or gastroduodenal artery despite the absence of a structural lesion involving the anastomosis, has occasionally been observed. We report a 20-year-old women who developed SAS with pancytopenia and refractory ascites after living donor liver transplantation despite intraoperative ligation of the splenic artery as a prophylactic treatment for SAS. In this case SAS was diagnosed by digital subtraction angiography (DSA). A celiac trunk angiogram showed relative hypoperfusion of the hepatic artery together with augmentation of the blood flow toward the spleen with the unique collateral circulation through the left gastric artery, stomach and short gastric artery, and distal splenic artery. Embolization of one of the two left gastric arteries was performed. After embolization the hepatic artery perfusion showed significant improvement, but reduced again the next day. We ultimately conducted splenectomy. This case showed portal hyperperfusion and portal hypertension, consistent with previous reports that have described an association of SAS with portal hyperperfusion. After splenectomy, there was significant improvement in the hepatic artery perfusion, ascites disappeared promptly, and pancytopenia was significantly improved.
キーワード
脾動脈症候群 (splenic artery syndrome)
脾動脈結紮 (ligation of the splenic artery)
生体肝移植 (living donor liver transplantation)
備考
症例報告 (Case Report)
発行日
2011-12-01
出版物タイトル
岡山医学会雑誌
出版物タイトル(別表記)
Journal of Okayama Medical Association
123巻
3号
出版者
岡山医学会
出版者(別表記)
Okayama Medical Association
開始ページ
207
終了ページ
211
ISSN
0030-1558
NCID
AN00032489
資料タイプ
学術雑誌論文
関連URL
http://www.okayama-u.ac.jp/user/oma/
参考文献
1) De Carlis L, Sansalone CV, Rondinara GF, Belli LS, Rimoldi P, Romani F, Puttini M, Meroni A, Riolo F, Rossetti O, et al. : Splenic artery steal syndrome after orthotopic liver transplantation : diagnosis and treatmet. Transplant Proc (1993) 25, 2594-2596.
2) Geissler I, Lamesch P, Witzigmann H, Jost U, Hauss J, Fangmann J : Splenohepatic arterial steal syndrome in liver transplantation : clinical features and treatment. Transpl Int (2002) 3, 139-141.
3) Uflacker R, Selby JB, Chavin K, Rogers J, Baliga P : Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovasc Intervent Radiol (2002) 25, 300-307.
4) Nussler NC, Settmacher U, Haase R, Stange B, Heise M, Neuhaus P : Diagnosis and treatment of arterial steal syndrome in liver transplant recipients. Liver Transpl (2003) 9, 603-604.
5) Mogl MT, Nussler NC, Presser SJ, Podrabsky P, Denecke T, Grieser C, Neuhaus P, Guckelberger O : Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transplant Int (2010) 23, 831-841.
6) Quintini C, Hirose K, Hashimoto K, Diago T, Aucejo F, Eghtesad B, Vogt D, Pierce G, Baker M, Kelly D, Miller CM : Splenic artery steal syndrome is a misnomer : the cause is portal hyperperfusion, not arterial siphon. Liver Transpl (2008) 14, 374-379.
7) Lautt WW : Relationship between hepatic blood flow and overall metabolism : the hepatic arterial buffer response. Fed Proc (1983) 42, 1662-1666.
8) Richter S, Vollmar B, Mucke I, Post S, Menger MD : Hepatic arteriolo-portal venular shunting guarantees maintenance of nutritional microvascular supply in hepatic arterial buffer response of rat liver. J Physiol (2001) 1, 193-201.
9) Kirbas I, Ulu EM, Ozturk A, Coskun M, Harman A, Ogus E, Haberal M : Multidetector computed tomographic angiography findings of splenic artery steal syndrome in liver taransplantation. Transplant Proc (2007) 39, 1178-1180.
言語
Japanese
OAI-PMH Set
岡山大学
著作権者
Copyright (c) 2011 岡山医学会
論文のバージョン
publisher
査読
有り
DOI
Sort Key
5
Eprints Journal Name
joma