失代償肝硬化合并膽囊結石的自體骨髓肝內輸注治療

劉保池，李壘，司炎輝，張偉偉，劉新，劉啟領(上海市公共衛生臨床中心外科，上海201508)

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失代償肝硬化合并膽囊結石的自體骨髓肝內輸注治療

劉保池，李壘，司炎輝，張偉偉，劉新，劉啟領
(上海市公共衛生臨床中心外科，上海201508)

[摘 要]目的 研究自體骨髓經門靜脈肝內輸注對失代償期肝硬化合并膽囊結石患者的療效。方法 觀察18例失代償期肝硬化合并膽囊結石患者，其中4例采用單純腹腔鏡膽囊切除手術；14例采用脾切除加自體骨髓經門靜脈輸注治療。結果 4例單純膽囊切除手術患者術中出血多，術后1年肝功能沒有改善。14例脾切除加自體骨髓經門靜脈輸注治療者，術后3個月肝功能基本恢復正常，其中4例脾切除手術時切除膽囊患者，術中出血多；3例1年后再次手術切除膽囊患者，手術順利。7例患者沒有切除膽囊，無明顯臨床癥狀。

結論 自體骨髓經門靜脈輸注治療可以促進失代償期肝硬化患者肝功能重建，肝功能好轉后再次手術膽囊切除可以降低手術風險。

[關鍵詞]肝硬化；膽囊結石；自體骨髓輸注

Autologous bone marrow transfusion for the treatment of gallbladder calculus with decompensated liver cirrhosis LIU Bao-chi, LI Lei, Si Yan-hui, ZHANG Wei-wei, LIU Xin, LIU Qi-ling.Department of Surgery, Shanghai Public Health Clinical Center Af■liated to Fudan University, Shanghai 201508, China

Abstract ObjectiveTo investigate the therapeutic effect of splenectomy and bone marrow transfusion (BMT) for the patients of decompensated liver cirrhosis with gallbladder calculus.MethodsSample cholecystectomy were performed in 4 patients, splenectomy and BMT were performed in 14 gallbladder calculus patients with decompensated liver cirrhosis.Cholecystectomy were also performed in 4 patients during splenectomy.Three patients were performed cholecystectomy one year after splenectomy and BMT.ResultsThere were huge volume bleeding during operation of sample cholecystectomy in 4 patients and no change of liver function one year after operation was found.The liver function restored after splenectomy and BMT in 14 patients.There was also huge volume bleeding in 4 patients during splenectomy and cholecystectomy.The operation were uneventfully in 3 patients who were performed cholecystectomy one year after splenectomy and BMT.Conclussion Splenectomy and BMT for the gallbladder calculus patient with decompensated liver cirrhosis can promote liver function reconstrauction.The cholecystectomy is safety for the patient with decompensated liver cirrhosis one year after splenectomy and BMT.

Key words liver cirrhosis； gallbladder calculus； autologous bone marrow transfusion

膽囊結石主要是通過手術治療，肝硬化患者比正常人群更容易發生膽囊結石。失代償肝硬化合并膽囊結石患者多伴有門靜脈高壓和凝血功能障礙，行膽囊切除術治療風險很高，一般禁忌手術。本單位對18例失代償期肝硬化合并膽囊結石患者進行手術治療，其中4例單純膽囊切除手術，14例采用脾切除加自體骨髓經門靜輸注治療，術后肝功能都明顯改善，現報道如下。……