背景：肝移植（LT）期间自发性门体分流（SPSS）的最佳治疗仍存在争议。我们系统地回顾了有关定义的文献，接受SPSS的患者接受LT的治疗和结果。
方法：根据系统评价和荟萃分析（PRISMA）指南的首选报告项目，我们使用PubMed检索了1987年1月至2020年1月期间所有与SPSS和LT相关的研究.主要终点是根据SPSS管理的定义和结果（治疗与观察）。
结果：检索到13个详细介绍962个SPSS管理的研究。血液动力学显著的SPSS被定义为41%(n=395)的患者直径≥10mm。SPSS为脾肾（42%），胃腔（15.2%），脐带缆(7.4%)，肠系膜腔（n=31；3.2%），肠系膜肾（0.1%）和未报告（31.9%），分别。在LT时,处理372个分流器(38.7%),同时观察到590个分流器(61.3%)。在4个月至5年的随访时间内，除一项研究外,报告的1年总生存期(OS)无显著差异.门静脉吻合并发症（即流量减少，狭窄或血栓形成）在观察到的[n=26（4％）]和结扎的SPSS[n=10（2％）]（p=0.22）中也有类似的报道，但在观察到的SPPS中，重新剖腹手术的比率显着高于观察到的SPPS（16vs2；p=0.01），以挽救LT门静脉血栓形成（n=6）并减少门静脉流量和移植物功能障碍（n=
结论：文献中在LT期间存在SPSS的异构管理。结扎SPPS并没有减少血管并发症，也没有提高生存率。一项随机前瞻性研究可能有助于确定LT时SPSS的最佳管理。
BACKGROUND: Optimal treatment of spontaneous portosystemic shunts (SPSS) during liver transplantation (LT) remains debated. We systematically reviewed the literature on definitions, treatment and outcomes of patients presenting SPSS undergoing LT.
METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used PubMed to retrieve all studies dealing with SPSS and LT between January 1987 and January 2020. The primary endpoints were definitions and outcomes according to the management of SPSS (treatment vs observation).
RESULTS: Thirteen studies detailing the management of 962 SPSS were retrieved. Hemodynamically significant SPSS were defined as those having diameter ≥ 10 mm in 41% (n = 395) of patients. SPSS were splenorenal (42%), cavo-gastric (15.2%), umbilical (7.4%), mesenterico-caval (n = 31; 3.2%), mesenterico-renal (0.1%) and unreported (31.9%), respectively. At the time of LT 372 shunts (38.7%) were treated while 590 were observed (61.3%). During a follow-up time ranging from 4 months to 5 years, the reported overall survival (OS) at 1 year was not significantly different except for one study. Portal vein anastomosis complications (i.e. reduced flow, stenosis or thrombosis) were similarly reported in observed [n = 26 (4%)] and ligated SPSS [n = 10 (2%)] (p = 0.22) but the rate of relaparotomy was significantly higher in observed SPPS (16 vs 2; p = 0.01) to rescue post LT portal vein thrombosis (n = 6) and reduced portal flow and graft dysfunction (n = 10).
CONCLUSIONS: There was a heterogeneous management of SPSS during LT in the literature. Ligation of SPPS did not reduce vascular complications neither improved survival. A randomized prospective study might contribute to identify best management of SPSS at time of LT.
