臨床外科64巻4号

2009年04月発行

特集 脾臓をめぐる最近のトピックス

生体肝移植過小グラフト例における脾動脈結紮および脾摘の意義

著者： 佐藤好信¹ 山本智¹ 大矢洋¹ 中塚英樹¹ 小林隆¹ 原義明¹ 渡辺隆興¹ 小海秀央¹ 畠山勝義¹

所属機関： ¹新潟大学大学院医歯学総合研究科消化器・一般外科

ページ範囲：P.477 - P.489

要旨：成人生体肝移植の過小グラフトにおける肝障害においては，単純に物理的な力である過剰なshear stressが原因となって，ビリルビン代謝の中心であるHO（heme oxygenase-1）-CO systemに影響し，直接ビリルビン優位の高ビリルビン血症を呈する．これらを改善するには，過剰なshear stressを緩和してやる必要がある．その外科的手段として脾動脈結紮，脾摘，そしてporto-caval shunt（門脈下大静脈シャント術）がある．脾動脈結紮の効果が一時的であること，脾摘には出血や門脈血栓のリスクがあることなど，それぞれの合併症も踏まえ，グラフト体重比や門脈圧亢進症の程度を鑑みて相応しい手技を選択すべきである．

参考文献

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