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中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 384 -387. doi: 10.3877/cma.j.issn.1674-0793.2018.06.004

所属专题: 文献

论著

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
党晓卫1,(), 李林1, 李路豪1, 付坤坤1, 李松1, 牛光辉1, 张中杰1   
  1. 1. 450052 郑州大学第一附属医院肝胆胰外科
  • 收稿日期:2018-04-18 出版日期:2018-12-01
  • 通信作者: 党晓卫
  • 基金资助:
    2013年河南省科技攻关计划项目(13210231511)

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

Xiaowei Dang1,(), Lin Li1, Luhao Li1, Kunkun Fu1, Song Li1, Guanghui Niu1, Zhongjie Zhang1   

  1. 1. Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2018-04-18 Published:2018-12-01
  • Corresponding author: Xiaowei Dang
  • About author:
    Corresponding author: Dang Xiaowei, Email:
引用本文:

党晓卫, 李林, 李路豪, 付坤坤, 李松, 牛光辉, 张中杰. 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[J/OL]. 中华普通外科学文献(电子版), 2018, 12(06): 384-387.

Xiaowei Dang, Lin Li, Luhao Li, Kunkun Fu, Song Li, Guanghui Niu, Zhongjie Zhang. Effects of modified splenopneumopexy combined with autologous peripheral blood stem cell transplantation on variceal bleeding of portal hypertension[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(06): 384-387.

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(χ2=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(χ2=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'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.

表1 门静脉高压症上消化道出血患者基本临床资料比较
表2 门静脉高压症上消化道出血患者手术前后实验室指标分析(±s
图1 两组门静脉高压症上消化道出血患者术后再出血时间对比
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