肝移植治疗肝性脊髓病的临床讨论

Discussion of liver transplantation for the treatment of hepatic myelopathy

肝性脊髓病是继发于终末期肝病的一种特殊类型的神经系统改变，是以脊髓病变为主要症状的综合征，多于自然形成的广泛的门体静脉侧支循环或门体静脉分流术后出现，临床比较罕见。该病预后不良，病情呈慢性进展。目前的治疗方法主要是针对原发肝病进行干预。外科医师为减少毒性物质的吸收行结肠游离手术或回肠直肠吻合术，短期内可降低血氨和改善神经症状，但长期效果不理想。2012年4月大连医科大学附属二医院收治1例肝性脊髓病患者。该例患者行肝移植术后临床症状、体征及生命质量均获得明显改善，双下肢肌力得到有效恢复。肝移植是从病因上治疗肝性脊髓病的有效方法。

Hepatic myelopathy is one of special category changes of nervous system, which was secondary to the end-stage hepatic diseases and is a syndrome of myeleterosis. It usually occurred after portosystemic shunt surgery or collateral circulation of portosystemic vein. The prognosis of hepatic myelopathy is poor, and the progression of this disease is slow. Surgical approaches such as dissociation of colon and anastomosis of ileum and rectum aimed at reducing the absorption of toxic substance and thus to breakdown the blood ammonia and improve the symp- toms of nervous system, but the effects are not satisfactory. The clinical data of 1 patient with hepatic myelopathy who received liver transplantation at the Second Mfiliated Hospital of Dalian Medical University in April 2012 were retrospectively analyzed. The clinical symptoms and physical signs were improved, and muscle strength was effectively recovered in the patient. Liver transplantation might be an effective method for the treatment of hepatic myelopathy.