肝炎肝硬变门脉高压症患者脾切除与脾切除后自体脾组织移植的临床对照研究

目的 探讨脾切除／自体脾组织移植在肝硬变门脉高压症治疗中的作用。方法 42例肝炎肝硬变门脉高压症患者行脾切除和贲门周围血管离断术治疗。其中20例同时行自体脾组织移植。观察脾切除组与脾切除自体脾组织移植组手术前后白细胞、血小板、血清免疫球蛋白、补体的含量、NK细胞活性以及T淋巴细胞转化率的变化。结果 两组IgG和IgA术前与术后相比较无显著差异（P〉0．05）。移植组术后2周、6月和1年血清IgM水平与脾切除组差异有统计学意义（P〈0．05）；术后3月两组IgM有显著性差异（P〈0．01）。移植组C3术后明显升高，脾切除组C3值术后较术前无明显变化。移植组与脾切除组C3术后3个月至1年有显著性差异（P〈0．01）。脾切除组术后半年NK细胞活性明显低于术前水平，移植组与脾切除组NK细胞术后3个月、6个月、1年与术前有显著性差异（P〈0．01）。移植组与脾切除组T淋巴细胞转化率术后3个月至1年有显著性差异（P〈0．01）。结论 肝炎肝硬变门脉高压症患者在脾切除／自体脾组织移植术后的免疫功能较非移植组有明显的提高。

A comparative study of splenectomy and splenectomy with auto-spleen transplantation in the treatment of cirrhotic portal hypertension

Objective To investigate the significance of auto-splenic transplantation in the treatment of cirrhotic portal hypertension. Methods Splenectomy and extensive esophagogastric devascularization were applied to 42 patients with portal hypertension. 20 were treated with auto-splenic transplantation. The changes of serum immunoglobulin, activity of natural killer cells and the transformation rate of T-lymphocytes before and after the operation were compared. Results No differences(P>0.05)were found in serum IgG and IgA between the two groups. The serum IgM and C3 levels increased two, six and twelve months after auto-splenic transplantation (P<0.05 ). After six months of splenectomy, the activity of natural killer cells decreased evidently. Conclusion The immune function increased in the patients receiving splenectomy and auto-splenic transplantation.