自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

Splenic autotransplantation pins lower esophagus transaction for the treatment of portal hypertension

目的本研究比较自体脾移植联合食管横断吻合术与脾切除联合食管横断吻合术治疗门静脉高压症（PHT）的疗效。方法将30例研究对象平均分为两组。研究组行脾次全切除加自体脾腹膜后移植及食管横断吻合术；对照组行脾切除加食管横断吻合术。于术前1周及术后6个月通过三维动态增强磁共振血管成像（3D DCE MRA）检测其门静脉主干（MPV）管腔横截面积、血流量、血流速度等门静脉系统血流动力学参数及食管胃底曲张静脉的变化，并观察自体移植脾在腹膜后的侧支血管形成与血流方向的改变。并同步检查血清肝纤维化指标及肝功能的重要指标。结果术后两组MPV的管腔横截面积、MPV的平均流速和MPV的平均流量均比术前明显减小（P〈0．05）。且术后研究组MPV的平均流速和平均流量均少于对照组（P〈0．05）。两组手术后胃底曲张静脉、食管曲张静脉均消失或明显改善；两组手术前后肝功能的重要指标均差异无统计学意义（P〉0．05）。研究组血清透明质酸水平在术后显著下降（P〈0．05），研究组移植脾成活良好，并建立了广泛的侧支循环。结论自体脾移植联合食管横断吻合术是一种优于脾切除加断流术治疗肝硬化PHT的方法，且未对肝功能造成负面影响。

Objective To evaluate the efficacy of splenic autotransplantation plus lower esophagus transaction for the treatment of portal hypertension （PTH）. Methods Thirty patients were divided into study group （15 cases） and control group （15 cases）. Patients in study group underwent splenic autotransplantation after splenectomy and cardia-esophageal devascularization plus lower esophagus transaction, and those in control group had all except splenic autotransplantation. The cress section area, blood velocity, blood flow of MPV （main portal vein） and changes of cardia-esophageal varices were evaluated by 3D DCE MRA at 1 week before operation and 6 months after, and blood flow and collateral circulation of transplanted spleen in the retroperitoneal space were assessed. Results In both groups, the cross section areas （ cm^2 ）, mean blood velocity （cm/s） and mean blood flow （ml/s） of MPV decreased postoperatively （P 〈 0. 05 ）. The postoperative cross section areas （cm^2） and mean blood velocity （cm/s） of MPV in study group were smaller than that in control group （ P 〈 0. 05 ）. Esophageal and fundal variceal veins disappeared or improved equally in both groups. There was no difference in the postoperative and preoperative liver function between the two groups （ P 〉 0. 05 ）. In study group, the planted spleen grew well in the retroperitoneal space, and with a formation of extensive collateral circulation. The postoperative serum hyaluronic acid decreased in this group （ t = 2. 929, P 〈 0. 05 ）. Conclusion Splenic autotransplantation after splenectomy plus lower esophagus transection was effective for the treatment of PHT without adverse impact on liver function.