断流术对肝硬化患者术后肝纤维化的影响

Effect of devascularization on the postoperative liver fibrosis in patients with liver cirrhosis

目的 探讨脾切除贲周血管离断术对乙肝肝硬化门静脉高压症患者无创性肝纤维化指标及肝功能的影响.方法 20例未经抗病毒治疗的乙肝肝硬化门脉高压患者,Child-PughA级12例,B级8例,分别于断流术前后,采用ELISA法测定血清PDGF、CTGF;电化学发光法测定透明质酸（HA）、三型前胶原（PcⅢ）、层黏连蛋白（LN）、四型胶原（cⅣ）;采用全自动生化分析仪及血细胞计数仪测定总胆红素（TBIL）、转氨酶（AST、ALT）、胆碱酯酶（CHE）、前白蛋白（PA）、WBC及PLT.结果 ①血清PDGF、CTGF及肝纤四项指标较术前明显下降.②总胆红素（TBIL）较术前明显降低;前白蛋白（PA）、胆碱酯酶（CHE）较术前有所升高,差异明显.③白细胞、血小板较术前升高差异有统计学意义.结论 断流术不仅能够减少肝硬化门静脉高压的多种并发症,同时在改善肝功能、凝血功能及延缓肝纤维化的发展上起了重要作用.

Objective To discuss the effect of splenectomy and pericardial revascularization on non-invasive indexes of liver fibrosis and function in portal hypertensive patients with HBV-related cirrho- sis. Methods Twenty portal hypertensive patients with HBV-related cirrhosis were enrolled. All patients were under Child-Pugh stage C and they did not receive antiviral therapy before. ELISA method was used to test the level of serum platelet derived growth factor （PDGF） and connective tissue growth factor （ CT- GF） ; electrochemiluminescence was used to measure hyaluronic acid（ HA）, N-terminal type m procolla- gen peptide （ PC- m ）, laminin （LN） and collagen type IV （ c IV ） ; total bilirubin （ TIBL）, aspartate and ala- nine transaminases （ AST, ALT）, cholinesterase （ CHE ）, prealbumin （ PA ） and number of white blood cell （WBC） and platelet （PLT）were measured by biochemical and blood cell analyzer. Results The serum PDGF, CTGF, HA, Pc m, LN, c IV and TBIL were obviously lower than the preoperative levels. The CHE, PA and amount of WBC and PLT were significantly higher than the preoperative levels. Conclusion Peri- cardial revascularization can reduce a variety of complications of cirrhotic portal hypertention. Moreover, it plays an important role in improving liver function, enhancing blood coagulation and delaying the develop- ment of liver fibrosis.