改良脾-肺固定联合外周血干细胞移植治疗门静脉高压症上消化道出血的疗效分析

Effects of modified splenopneumopexy combined with autologous peripheral blood stem cell transplantation on variceal bleeding of portal hypertension

目的探讨改良脾-肺固定联合外周血干细胞移植(APBSCT)治疗门静脉高压症上消化道出血的疗效。方法收集2010年3月至2014年12月在郑州大学第一附属医院就诊且随访资料完善的门静脉高压症上消化道出血患者资料,其中行改良脾-肺固定术的31例患者设为对照组,联合应用APBSCT的17例患者为试验组。对比分析两组患者术后3、6个月时天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白(ALB)水平,应用超声多普勒检测术后3个月时脾-肺之间侧支循环形成情况,采用Kaplan-Meier生存曲线和Log-rank检验比较两组患者再出血时间差异。结果两组患者术后3、6个月时AST、TBIL水平比较,差异无统计学意义;但试验组ALB水平均高于同期对照组,差异有统计学意义(t=-2.399、2.152,P=0.021、0.037)。术后3个月时,对照组中11例无明显侧支循环形成,未形成率为35.48%(11/31),显著高于试验组的5.88%(1/17),两组比较差异有统计学意义(χ~2=5.131,P=0.024)。试验组中1例于术后12个月时发生消化道再出血,对照组中10例发生消化道再出血,其中3例于术后3个月内出现,两组再出血时间比较差异有统计学意义(χ~2=4.362,P=0.037)。结论外周血干细胞移植能够促进改良脾-肺固定术后脾-肺之间侧支循环的建立,减少再出血风险,改善肝脏合成功能,值得进一步推广应用。

Objective：To investigate the effects of modified splenopneumopexy combined with autologous peripheral blood stem cell transplantation （APBSCT） on variceal bleeding of portal hypertension. Methods：The clinical data of patients with variceal bleeding of portal hypertension who were admitted to the First Affiliated Hospital of Zhengzhou University between March 2010 and December 2014 were collected. Thirty-one patients who underwent modified splenopneumopexy were set as control group, and 17 of modified splenopneumopexy combined with APBSCT therapy were set as trial group. The levels of aspartate aminotransferase （AST）, total bilirubin （TBIL）, albumin （ALB） 3 months and 6 months after operation, the formation of collateral circulation between spleen and lung 3 months after operation were compared between the two groups. The difference of re-bleeding time between the two groups was analyzed by Kaplan-Meier survival curve and Log-rank test. Results：There were no significant differences in serum AST, TBIL between the two groups at 3rd month and 6th month after operation. However, serum ALB in the trial group was significantly higher than the control group concurrently, with significant differences （t=-2.399, 2.152; P=0.021, 0.037）. Eleven patients in the control group didn＆#39;t have obvious collateral circulation at the 3rd month after operation, the collateral circulation unformed rate was 35.48% （11/31）, significantly higher than the trial group （5.88%, 1/17）, the difference was statistically significant （χ2=5.131, P=0.024）. One patient in the trial group showed re-bleeding of the digestive tract at the 12th month after surgery, while 10 patients re-bled in the control group, 3 of which happened within 3 months after surgery, the difference of re-bleeding time between the two groups was statistically significant （χ2=4.362, P=0.037）. Conclusion：APBSCT can promote the establishment of collateral circulation between the spleen and the lung after modified splenopneumopexy, reduce the risk of rebleeding and improve the liver synthesis function, which deserves further application.