自体骨髓移植治疗失代偿期肝硬化的临床观察  

Clinical observation of autologous bone marrow transplantation in treatment of decompensated cirrhosis

作　　者：刘保池[1,2] 郎林 李垒 司炎辉[1] 李爱军[3] 徐庆 夏磊[4] 张辉[5] LIU Bao-chi;LANG Lin;LI Lei;SI Yan-hui;LI AI-jun;XU Qing;XIA Lei;ZHANG Hui(Department of General Surgery,Shanghai Public Health Clinical Center,Shanghai 201508,China;Department of Surgery,Shanghai New Hongqiao International Medical Center Heno Medical,Shanghai 200240,China;Department of Special Needs,East Hospital of Hepatobiliary Surgery Affiliated to Naval Military Medical University,Shanghai 200433,China;Department of General Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200120,China;Department of General Surgery,Oriental Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]上海市公共卫生临床中心普外科,上海201508 [2]上海新虹桥国际医学中心和诺医疗外科,上海200240 [3]海军军医大学附属东方肝胆外科医院特需科,上海200433 [4]上海交通大学附属仁济医院普外科,上海200120 [5]同济大学附属东方医院普外科,上海200120

出　　处：《肝胆胰外科杂志》2020年第10期585-589,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：申康医院发展中心资助课题(SHDC12016129)。

摘　　要：目的研究自体骨髓经门静脉输注对失代偿期肝硬化的治疗作用。方法回顾性分析2016年1月到2019年12月对失代偿期肝硬化患者做自体骨髓经门静脉输注的临床资料。其中30例进行常规药物保肝利尿等治疗,52例常规治疗+自体骨髓经门静脉输注,55例常规治疗+脾切除+自体骨髓经门静脉输注。结果30例进行常规治疗后1个月和3个月与治疗前相比肝功能和血常规各项指标没有好转;2例死于消化道出血。52例常规治疗+门静脉自体骨髓输注治疗后1个月和3个月肝功能指标明显好于常规治疗(P<0.05);2例死于消化道出血。55例常规治疗+脾切除+自体骨髓经门静脉输注治疗后1和3个月肝功能指标明显好于常规治疗(P<0.05);3例手术后1周内死于创面出血诱发的肝衰竭。治疗3个月后,常规治疗+脾切除+自体骨髓经门静脉输注、常规治疗+自体骨髓经门静脉输注与常规治疗相比,在白细胞数[(6.28±1.63)×10^9,(3.39±0.98)×10^9,(3.04±0.65)×10^9]、血红蛋白量[(107.16±19.25)g/L,(98.66±19.81)g/L,(92.54±17.52)g/L]、血小板数[(223.00±47.99)×10^9,(45.52±12.93)×10^9,(38.64±9.48)×10^9]方面均明显增高(P<0.05)。结论常规治疗对失代偿期肝硬化没有明显疗效。常规治疗加自体骨髓经门静脉输注可以明显促进失代偿期肝硬化的肝功能重建,但是不能缓解脾功能亢进。脾切除加自体骨髓经门静脉输注可以解除脾功能亢进,并促进失代偿期肝硬化的肝功能重建,但是脾切除术后创面渗血容易诱发肝衰竭,有较高手术风险。对肝功能C级的失代偿期肝硬化可以先作上腹部小切口经网膜右静脉插管输注自体骨髓,待肝功能好转后,再做脾切除,可以降低手术风险。Objective To study the therapeutic effect of autologous bone marrow through portal vein infusion on decompensated cirrhosis.Methods Clinical data of patients with decompensated cirrhosis who received autologous bone marrow transfusion via portal vein from Jan.2016 to Dec.2019 were retrospectively analyzed.Among them,30 patients were treated with conventional drugs with the efficacy of liver protection and diuresis;52 patients were treated with routine treatment+autologous bone marrow through portal vein infusion;55 patients were treated with routine treatment+splenectomy+autologous bone marrow through portal vein infusion.Results For the 30 patients undergoing routine treatment,liver function and blood routine indicators did not improve 1 and 3 months after treatment;and two patients died of gastrointestinal bleeding.For the 52 patients undergoing routine treatment+autologous bone marrow through portal vein infusion,liver function indexes were improved significantly 1 and 3 months after treatment(P<0.05);and 2 patients died of gastrointestinal bleeding.For the 55 patients undergoing routine treatment+splenectom+autologous bone marrow through portal vein infusion,liver function indexes were improved significantly 1 and 3 months after treatment compared with those receiving routine treatment(P<0.05);and 3 patients died of liver failure induced by wounds within 1 week after operation.Three months after surgery,compared with patients undergoing routine treatment,white blood cells count[(6.28±1.63)×10^9,(3.39±0.98)×10^9,(3.04±0.65)×10^9)],hemoglobin level[(107.16±19.25)g/L,(98.66±19.81)g/L,(92.54±17.52)g/L]and platelets count[(223.00±47.99)×10^9,(45.52±12.93)×10^9,(38.64±9.48)×10^9]were significantly increased(P<0.05)in patients receiving routine treatment+splenectomy+autologous bone marrow through portal vein infusion,and patients receiving routine treatment+autologous bone marrow through portal vein infusion.Conclusion Routine treatment has no obvious effect on decompensated cirrhosis.Routine treatmen

关 键 词：肝硬化失代偿期 自体骨髓移植 脾切除 肝功能重建 

分 类 号：R657.3[医药卫生—外科学]