门脉高压症治疗的一种新策略--自体脾移植及食管横断吻合术的30年疗效观察  

30 years clinical observation of portal hypertension treatment of a new strategy of splenic autotransplantation with lower esophagus transection

作　　者：张磊[1] 马靖[2] 张杰[3] 张红卫[1] 霍景山[4] 陈积圣[1] 

机构地区：[1]中山大学孙逸仙纪念医院肝胆胰外科,广东广州510120 [2]广东省佛山市顺德第一人民医院普外二区,广东佛山528000 [3]中山大学孙逸仙纪念医院小儿外科,广东广州510120 [4]佛山市中医院普外科,广东佛山528000

出　　处：《世界最新医学信息文摘》2013年第17期41-42,46,共3页World Latest Medicine Information Electronic Version

摘　　要：目的：进行自体脾移植及食管横断吻合术对脉高压症进行治疗的临床与基础研究。方法采用临床前瞻性研究、随机对照免疫学研究以及门脉血流动力学3D DEC MRA（三维动态增强磁共振血管成像）研究对行腹膜后自体脾移植联合食管横断吻合术治疗肝硬化门脉高压症进行疗效评估及与传统脾切除术＋断流术进行对比。结果自体脾移植组术后门脉高压性胃炎出血率、术后肝癌发生率等临床指标无明显升高，术后血清tuftsin、IgM水平高于切脾组，差异有显著性意义（P〈0.05），而对肝功能无明显影响，且移植脾成活良好、建立了良好的血供及侧枝循环。结论自体脾移植联合食管横断吻合术治疗肝硬化门脉高压症，不仅纠正脾亢，治疗出血效果确切，手术安全有效，而且保存了脾脏免疫功能，为门脉高压症可供选择的一种新疗法。Objective The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.Methods In this study, we evaluated the effectiveness of a new treatment strategy：splenic auto transplantation and oesophageal transection anastomosis from three aspects：clinical observation, splenic immunology and portal dynamics. Results Patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes, which were then compared with those of the traditional surgery treatment. Among all patients, the emergency operative mortality, selective operative mortality, complication rate, morbidity of hepatic encephalopathy, bleeding rate of portal hypertension gastritis, and morbidity of hepatic carcinoma were similar to those under traditional operation;the spleen immunology function （Tuftsin, IgM） decreased among the groups 2 months after operation without statistic signiifcance. The cross section area, the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups, the auto transplantation group was signiifcantly lower in velocity and volume of blood lfow than in the control group. Conclusion Splenic auto transplantation and esophageal transection anastomosis are a safe, effective, and reasonable treatment strategy for portal hypertension with varicial bleeding. It can not only correcthypersplenism but also completely stanch blood, and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

关 键 词：门静脉高压 脾移植 自体 3DDECMRA 

分 类 号：R657.3[医药卫生—外科学]