自体骨髓对失代偿期肝硬化合并小肝癌的治疗  

Treatment of small hepatocellular carcinomas with decompensated liver cirrhosis by autologous bone marrow

作　　者：刘保池[1] 冯铁男[2] 李垒[1] 司炎辉[1] 张伟伟[1] 刘新[1] 刘启领 LIU Bao-chi;FENG Tie-nan;LI Lei;SI Yan-hui;ZHANG Wei-wei;LIU Xin;LIU Qi-ling(Department of Surgery, Shanghai Public Health Clinical Center, Shanghai 201508, China;School of Public Health, Shanghai Jiaotong University, Shanghai 200025, China)

机构地区：[1]上海市公共卫生临床中心外科,上海201508 [2]上海交通大学公共卫生学院,上海200025

出　　处：《肝胆胰外科杂志》2017年第3期188-191,195,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：上海市卫生计生委课题(20134366);申康医院发展中心资助课题(SHDC12016129)

摘　　要：目的研究在自体骨髓经门静脉输注改善肝功能的基础上对失代偿期肝硬化合并小肝癌进行综合治疗。方法自2010年1月至2015年12月,上海市公共卫生临床中心对12例失代偿期肝硬化合并小肝癌患者,施行经网膜右静脉插管埋置输液港,做自体骨髓经输液港输注进入门静脉改善肝硬化,在肝功能改善后,进行介入栓塞治疗和射频治疗小肝癌。结果自体骨髓经输液港输注进入门静脉后肝功能有明显改善。白蛋白总体呈上升趋势,上升趋势通过简单线性回归计算得出有统计学意义(P<0.0001);总胆红素变化没有统计学意义(P=0.50);凝血酶原时间缩短(P<0.0001);肝功能评分呈现显著下降趋势(P<0.0001)。介入栓塞和射频消融治疗后小肝癌病灶缩小或完全坏死纤维化。2例术后12个月内死于消化道出血,2例术后24个月内死于肝癌转移,其余8例均在肝功能大致正常状态下存活,最长随访时间已经超过6年。结论自体骨髓经门静脉输注后可以明显改善肝功能,然后作介入栓塞和射频消融控制小肝癌,食管下段曲张静脉内镜套扎治疗防止消化道出血,可以使失代偿期肝硬化合并小肝癌患者在肝功能恢复正常的状态下长期存活。Objective To study the autologous bone marrow through portal vein infusion to improve liver function in patients of small hepatocellular carcinomas with decompensated liver cirrhosis.Methods The infusion port was embedded in the right retinal vein intubation through which bone marrow was injected into the portalvein.After liver function was improved,interventional embolization and radiofrequency ablation were used to treat small hepatocellular carcinoma lesions.Results Liver function after autologous bone marrow entered into the portal vein through port infusion improved significantly.The protein level improved with significance that was calculated by linear regression(P<0.0001).No significant change of total bilirubin was found(P=0.50).The time of prothrombin decreased(P<0.0001)and the score of liver function decreased significantly(P<0.0001).After the surgery,the small hepatocellular carcinoma lesions atrophied or completely became necrosis and fibrosis.2cases died of digestive tract hemorrhage within12months.2cases died of liver cancer metastasis within24months.Other8cases are still alive with normal liver function.The longest one has lived more than6years.Conclusion Autologous bone marrow through portal vein infusion can significantly improve the liver function.Then interventional embolization and radiofrequency ablation can control small hepatocellular carcinomas.Treatment of low esophageal varicose vein endoscopic ligation can prevent gastrointestinal bleeding.These treatments can make patients with small hepatocellular carcinomas with decompensated liver cirrhosis have a longer survival time with normal liver function.

关 键 词：肝硬化 癌 肝细胞 自体骨髓 消化道出血 综合治疗 

分 类 号：R575.2[医药卫生—消化系统] R735.7[医药卫生—内科学]