肝性脊髓病2例并文献复习

目的加强对肝性脊髓病的认识和重视。方法分析我院收治的2例肝性脊髓病患者临床资料并对相关文献进行复习。结果本病多数发生于肝硬化失代偿期之后,临床主要表现为缓慢进行性痉挛性截瘫,无肌肉萎缩、感觉障碍及括约肌功能障碍。可分为4期：神经症状前期、临床期、肝性脑病期、脊髓病期。病理变化主要是脊髓锥体束对称性脱髓鞘改变,可波及颈髓以下脊髓全长,以胸腰段多见和显著 一般采取保护和改善肝功能,预防肝硬化并发症,降低血氨及改善脊髓损害症状等综合治疗措施。结论本病是慢性肝病晚期出现的一种以脊髓锥体束缓慢进展性损害为主要表现的特殊类型的并发症,早期肝移植是肝硬化晚期合并肝性脊髓病的有效治疗手段。

Two cases of hepatic myelopathy and review of literature

Objective To pay more attention to the diagnosis of hepatic myelopathy（HM）. Methods Analized the clinic characteristic of HM in our hospital and reviewed some of relative conference articles. Results Most of HM developed after decompensated cirrhosis accompanied with slowing and progressive spastic paraplegia.There were no muscle myatrophy,ense handicap and musculus sphincter functional disorder.Four phase were divided in clinic：pre-symptom of nervous system phase, clinic phase,hepatic encephalopathy stage and spinal disease phase.The pathological characteristic of HM was symmetrical demyelinization change in pyramidal tracts of spinal cord and the spinal cord would be involved especially in thoracolumbar. Combined therapy should be used including protectiong and improvement of live function, preventing hepatocirrhosis complication,reducing biood ammonspinal akinesia and so on. Conclusion HM is a kind of complication which developed in the end of chronic live disease appearanced with the progressive damage of pyramidal tracts of spinal cord.Live transplant in the early phase of HM and decompensated cirrhosis is effective treatment.