经肝动脉骨髓干细胞移植治疗肝硬化的初步临床应用

Transplantation of bone marrow stem cells via hepatic artery in treatment of hepatocirrhosis:a preliminary clinical application

目的探讨经肝动脉自体骨髓干细胞肝内移植治疗失代偿期肝硬化的临床应用可能性及效果。方法20例失代偿期肝硬化患者,乙型肝炎后肝硬化19例,酒精性肝硬化1例。ChildPugh分级:A级2例,B级6例,C级12例。所有患者术前均行影像学及肝脏功能等检查。移植术当日抽取患者自体骨髓30～50ml,分离出骨髓干细胞,经肝固有动脉注入。对于造影发现肝内有单发小肝癌者,先行肝段超选择TACE治疗,再选择性插管至正常肝动脉供血区,注入骨髓干细胞。术后1周、2周、1月观察患者临床症状、体征,复查肝功能等实验室指标。结果2例造影发现合并单发小肝癌。20例患者中,14例有效,6例无效。所有病例术后均未出现发热、过敏反应及其他不适。结论经肝动脉行自体骨髓干细胞移植安全可行;部分肝硬化患者用此方法治疗近期有效;治疗中通过肝动脉造影可能发现其他影像学检查未能显现的早期肝癌。

Objective To explore the probability and effect of bone marrow stem cells transplantation (BMSCT) via hepatic artery in treatement of hepatocirrhosis. Methods Twenty patients with hepatocirrhosis underwent BMSCT, 19 of them were with hepatitis B and one was alcoholic hepatocirrhosis. The number of Child-Pugh grade A, B and C were separately 2, 6 and 12. A total of 30-50 ml self bone marrow was taken and separated into bone marrow stem cells in the operation day. After selective hepatic artery catheterization and DSA, the bone marrow stem cells were injected into the liver. If a small HCC was found during DSA, a super selective TACE was performed firstly. Then, marrow stem cells were injected into the no tumor area via corresponded hepatic artery branch. The clinical symptoms and laboratory testing obtained before BMSCT and after that in one week, two week and one month were compared. Results All patients displayed the typical DSA characteristics of hepatocirrhosis. Two cases of small HCC were diagnosed by DSA finding. Fourteen cases were clinically effective,and 6 cases were inefficacy. Neither fever nor other complications were observed. Conclusion BMSCT is safe and feasible. Some patients of hepatocirrhosis can get curative effect by this treatment. Meanwhile, DSA process can probably find small HCC that other imaging methods are difficult to show.