内镜下硬化治疗联合干细胞移植及TIPS手术治疗终末期肝病

Sequential regimen combining transplantation of bone marrow mesenchymal stem cells,transjugular intrahepatic portosystemic shunt and endoscopic sclerotherapy for patients with end-stage liver disease

目的探讨针对失代偿期肝硬化的两大临床表现即肝功能严重受损及门脉高压并发症的综合序贯治疗方案。方法选取2009年6月至2011年8月收治的22例失代偿期肝硬化患者,肝功能Child-Pugh分级B级12例,C级10例。22例均有重度食管静脉曲张,其中16例以呕血、黑便入院,6例以大量腹水入院。结果 16例采用内镜下硬化剂注射急诊止血13例成功,3例仍有活动性出血,遂行急诊TIPS。在出血停止后1～2周择期行自体骨髓间充质干细胞移植。另6例以大量腹水入院患者待腹水减少后再行干细胞移植。干细胞移植术后2～4周后择期行TIPS治疗。经随访观察,干细胞移植能明显改善肝功能状态,特别是白蛋白水平升高(P<0.05),凝血酶原时间缩短(P<0.05),腹水减少(P<0.05)。TIPS治疗后8例食管胃静脉曲张消失,14例明显减轻,随访半年内未再出血。结论采用内镜治疗、联合干细胞移植及TIPS的序贯方案,对肝硬化失代偿期患者严重并发症治疗有重要价值。

Objective To investigate the sequential therapy regimen for the severely impaired liver function and portal hypertension of patients with decompensated liver cirrhosis.Methods Twenty-two patients with decompensated liver cirrhosis and serious esophageal varices including 12 patients with Child-Pugh grade B and 10 patients with Child-Pugh grade C from June 2009 to August 2011 were recruited.Sixteen patients were admitted in the hospital for haematemesis or melena,and the other six patients for tense ascites.Results Endoscopic sclerotherapy was effective in 13 out of 16 patients with bleeding esophageal varices,and the other 3 patients were treated with emergent transjugular intrahepatic portosystemic shunt（TIPS）.Then all of the 16 patients were transplanted with autologous bone marrow mesenchymal stem cells（BMSCs） within 1 to 2 weeks after hemostasis.The 6 patients with tense ascites were transplanted with autologous BMSCs until the volume of ascites reduced.Within the next 2 to 4 weeks,all the 6 patients were treated with TIPS.The follow-up data showed that the BMSCs transplantation significantly improved the liver function,especially in elevating albumin level（P〈0.05）,shortening prothrombin time（PT）（P〈0.05）,and reducing ascites volume（P〈0.05）.After TIPS therapy,esophageal varices disappeared in 8 patients and diminished in 14 patients,without rebleeding in the following half of a year.Conclusion The sequential regimen combining BMSCs transplantation,TIPS and endoscopic sclerotherapy is effective for patients with end-stage liver disease.