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 combined with lower esophagus transaction in the treatment of hepatic cirrhosis induced portal hypertension

目的探讨腹膜后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的临床疗效。方法将2003年1月至2006年12月收治的36例肝硬化门静脉高压症患者随机分为自体脾移植组（n=18）和脾切除组（n=18），自体脾移植组接受脾切除、食管横断吻合及自体脾移植术，脾切除组接受脾切除、食管横断吻合术。于术前及术后2～6个月定期观察两组患者的一般情况、行脾脏放射性核素扫描，同时检测肝功能、血清促吞噬素（Tuftsin）及IgM水平，并行组间及手术前后比较分析。结果自体脾移植组患者术后2个月血清Tuftsin和IgM水平与术前比较无明显差异（P〉0．05），而脾切除组患者术后2个月血清Tuftsin和IgM水平较术前明显降低（P〈0．05）；自体脾移植术对患者肝功能无明显影响；术后2个月放射性核素扫描证实移植脾于腹膜后存活。结论自体脾移植对保留机体脾脏免疫功能具有重要价值，腹膜后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的临床效果确切，值得推广应用。

Objective To study the therapeutic effect of splenic autotransplantation combined with lower esophagus transaction anastomosis in the treatment of liver cirrhosis induced portal hypertension. Methods Thirty-six patients admitted from January 2003 to December 2006 were randomly divided into splenic autotransplantation group undergoing splenic autotransplantation after splenectomy combined with lower esophagus transaction anastomosis, and splenectomy group only undergoing splenectomy combined with lower esophagus transaction anastomosis. The general conduction, splenic scanning, liver function, and the level of serum Tuftsin and IgM of each patient were observed before and after operation. Results The levels of Tuftsin and IgM in splenic autotransplantation group were significant higher than that of splenectomy group 2 months after the operation, and the liver function showed no significant difference between these two groups. Splenic tissue was detected in the retroperitoneal space by ^99mTc-DRBC 2 months after operation. Conclusions Splenic autotransplantation combined with lower esophagus transaction anastomosis is a safe and effective treatment strategy for patients with liver cirrhosis induced portal hypertension, and the spleen tissue transplanted into the retroperitoneal space can partially preserve the immune function.