自体脾移植联合食管横断吻合术对肝硬化门静脉高压症患者肝纤维化和肝功能影响的临床研究

Clinical studies on hepatic fibrosis and liver function of splenic autotransplantation with lower esophagus transection in treatment of portal hypertension

目的探讨自体脾移植联合食管横断吻合术对肝硬化门静脉高压症(portal hypertension,PHT)患者肝纤维化和肝功能的影响。方法 20例行自体脾移植联合食管横断吻合术的PHT患者术前1周及术后6个月检测血清肝纤维化四项[血清透明质酸(hyaluronic acid,HA)、层黏连蛋白(laminin,LN)、血清Ⅲ型前胶原(procollagenⅢ,PC-Ⅲ)和Ⅳ型胶原(type Ⅳ collagen,C-Ⅳ)]及肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、总胆红素(TBL)、γ-谷氨酰转肽酶(γ-GGT)和碱性磷酸酶(ALP)]的变化。结果手术前后LN[术前(88.51±41.59)pg/mL,术后(85.28±42.74)pg/mL,t=0.276,P=0.790]、PC-Ⅲ[术前(11.27±5.23)ng/mL,术后(9.89±4.82)ng/mL,t=1.243,P=0.234]、C-Ⅳ[术前(120.33±35.72)ng/mL,术后(113.85±25.992)ng/mL,t=1.307,P=0.212]均无差异。HA术后为(99.57±46.05)mg/mL,明显低于术前(139.52±66.3705)mg/mL(t=2.929,P=0.01)。结论自体脾移植联合食管横断吻合术没有加速肝纤维化的进展,没有造成肝功能损害。

【Objective】To explore spleen autotransplantation with lower esophagus transection whether aggravating hepatic fibrosis and damaging liver function.【Methods】 Twenty patients underwent splenic autotransplantation and cardia-esophageal devascularization plus lower esophagus transection.The serumal level of HA,LN,PC-III,C-Ⅳ and hepatic functional parameters were tested at equal pace.【Results】 The postoperative and preoperative serumal level of LN [postoperative（85.28±42.74）pg/mL,preoperative（88.51±41.59）pg/mL,t =0.276,P =0.790],PC-III [postoperative（9.89±4.82）ng/mL,preoperative（11.27±5.23）ng/mL,t =1.243,P = 0.234] and C-Ⅳ [postoperative（113.85±25.992）ng/mL,preoperative（120.33±35.72）ng/mL,t =1.307,P =0.212] were not different.The postoperative serumal level of HA was lower than that of the preoperative [postoperative（99.57±46.05）mg/mL,preoperative（139.52±66.3705）mg/mL,t =2.929,P =0.01].The periopertive liver functional parameters were not different.【Conclusion】 The results of testing hepatic fibrosis index,liver function parameters,hepatic volume and signals suggested that the preserved spleen don＇t encourage progress of hepatic fibrosis,and don＇t have bad effects on liver function.