自体脾移植及食管横断吻合术后门静脉高压症患者肝脏形态学改变的MR研究

Morphologic changes of liver in patients with portal hypertension performed splenic autotransplantation with lower esophagus transection by MR assessment

目的探讨自体脾移植及食管横断吻合术对肝硬化门静脉高压症(PHT)患者肝脏形态学改变的影响。方法将40例PHT患者随机分为研究组和对照组,各20例,均进行食管横断吻合术,对照组做全脾切除,研究组脾部分腹膜后移植。手术前后用磁共振(MR)测量肝体积及形态学的变化。结果术前研究组肝体积为(1054.06±289.66)cm3,对照组为(1108.72±253.84)cm3,两组肝体积差异无统计学意义。手术后研究组肝体积为(1063.74±193.13)cm3,对照组为(1092.25±206.44)cm3,两组肝体积差异无统计学意义。MR检查手术前后肝脏表面、肝裂、肝实质细网状或粗网状结构显像无差异,但㈦对照组相比,研究组术后肝内结节影像有所改善(P<0.05)。结论自体脾移植及食管横断吻合术没有促进肝纤维化的进展。

Objective To explore spleen autotransplantation with lower esophagus transection whether aggravating hepatic fibrosis by MR checking. Methods Forty patients with liver cirrhosis complicated with portal hypertension were randomly divided into two groups： study group（20 cases）, patients in which underwent sple nectomy with retroperitoneal splenic autotransplantation and cardia-esophageal devascularization, and control group（20 cases）, only with splenectomy and cardia-esophageal devascularization operation. The hepatic volume and signals of liver surface and parenchyma were respectively evaluated by MR at one week before operation and six months after operation. Results In two groups, the preoperative hepatic volume of study group was （1054.06 ± 289.66） cm3, which was no different with that of control group （1108.72 ± 253.84） cm3. The postoperative volume of study group was （1063.74 ± 193.13） cm3, which was no different with that of control group （1092.25 ± 206.44） cm3. In two groups, 3D DCE MR imaging showed that the perioperative hepatic surface signals were no different statistically with that of postoperation, and no progression of hepatic fibrosis was found, while in study group postoperative cirrhotic nodus images were improved（P〈0.05）. Conclusion The results of the hepatic volume and signals suggest that the preserved spleen won＇t encourage progress of hepatic fibrosis.