CAJ | 학술논문

目的：探讨和评价经颈内静脉肝内门体分流术联合脐带血干细胞经肝动脉灌注移植治疗肝硬化的有效性和安全性。方法50例失代偿期肝硬化患者，随机分为治疗组及对照组：治疗组30例，在内科治疗基础上采用 T IPS联合脐带血干细胞移植。对照组20例，仅采用内科药物治疗。两组性别、年龄、病理构成及Child-Pugh分级均具有同质性。术前1周、术后1月及术后3月观察2组患者丙氨酸氨基转移酶（ALT）、前白蛋白（PA）、总胆红素（TBIL）水平变化、临床症状改善及并发症情况。结果 TIPS手术及干细胞移植顺利，2组患者术前ALT、PA、TB均无明显差异；对照组药物治疗前后肝功能无特殊变化；治疗组患者术后3月时ALT（36.47±3.53U/L）较术前减低，PA（86.26±12.44mg/L）较术前明显升高（P＜0.05），但仍低于正常下限（100mg/L）。术后1月（76.67％ VS 35.00％）、3月（86.67％ VS 40.00％）治疗组总有效率均优于对照组（P＜0.01）。治疗组术后肝性脑病1例，穿刺点周围血肿2例，干细胞移植后低热2例，均经对症治疗后好转。术后3月肝胆CT检查分流道通畅，未见占位病变。结论 T IPS联合干细胞移植治疗终末期肝病在降低门脉压的同时改善了肝脏功能，操作安全可靠、近期效果确实。如何提高干细胞定植分化的几率，最佳的移植途径，是否需多次移植，肝功能改善的具体机制及其远期安全性仍需我们进一步研究。
목적：탐토화평개경경내정맥간내문체분류술연합제대혈간세포경간동맥관주이식치료간경화적유효성화안전성。방법50례실대상기간경화환자，수궤분위치료조급대조조：치료조30례，재내과치료기출상채용 T IPS연합제대혈간세포이식。대조조20례，부채용내과약물치료。량조성별、년령、병리구성급Child-Pugh분급균구유동질성。술전1주、술후1월급술후3월관찰2조환자병안산안기전이매（ALT）、전백단백（PA）、총담홍소（TBIL）수평변화、림상증상개선급병발증정황。결과 TIPS수술급간세포이식순리，2조환자술전ALT、PA、TB균무명현차이；대조조약물치료전후간공능무특수변화；치료조환자술후3월시ALT（36.47±3.53U/L）교술전감저，PA（86.26±12.44mg/L）교술전명현승고（P＜0.05），단잉저우정상하한（100mg/L）。술후1월（76.67％ VS 35.00％）、3월（86.67％ VS 40.00％）치료조총유효솔균우우대조조（P＜0.01）。치료조술후간성뇌병1례，천자점주위혈종2례，간세포이식후저열2례，균경대증치료후호전。술후3월간담CT검사분류도통창，미견점위병변。결론 T IPS연합간세포이식치료종말기간병재강저문맥압적동시개선료간장공능，조작안전가고、근기효과학실。여하제고간세포정식분화적궤솔，최가적이식도경，시부수다차이식，간공능개선적구체궤제급기원기안전성잉수아문진일보연구。
Objective To evaluate the efficacy and safety of Tansjugular Intrahepatic Portosystemic Shunt (TIPS) togetherwith human um-bilic cord blood stem cell transplantation through hepatic artery in treatment of patients with liver cirrhosis .Methods 50 patients were divided into treatment group (30 patients) and control group (20 patients) randomly .Sex and age structure ,pathological type and Child-Pugh grading showed no different between 2 groups .Control group only used drugs ,while the treatment group adopted TIPS and umbilic cord blood stem cell transplan-tation besides drugs .Alanine aminotransferase (ALT) ,prealbumin (PA) and total bilirubin (TIBL) were measured and analyzed in each group at pre-operation ,1 month and 3 months after transplantation .Clinical symptoms and adverse reaction was observed also .Results TIPS and transla-tion was carried out successfully .There had no significant difference of ALT ,PA and TIBL between 2 groups pre-operation .It also showed no sig-nificant change in the control group .Yet the level of ALT decreased while PA increased significantly at 3 months after transplantation(P<0.05) in treatment group .But PA(86.26 ± 12.44mg/L)was still subaverage(lower limit 100mg/L) .The overall response rate(OR) between the treat-ment group and the control group was 76.67% VS 35.00% at 1 month and 86.67% VS 40.00% at 3 months after transplantation(P<0.01) .He-patic encephalopathy occurred in 1 patient ,hematoma around puncture site was found in 2 patients ,and 2 patients got low fever after transplanta-tion .All those patients mended after symptomatic treatment .Upper gastrointestinal hemorrhage was found or reappeared in 5 patients in control group ,while none was found in the treatment group .No occupying lesions was detected in liver by CT at 3 month post-transplantation and no stent was obstructed .Conclusion TIPS togetherwith human umbilic cord blood stem cell transplantation could decrease the pressure of portal veins and improve hepatic function in patients with cirrhosis .It was a safe and recommendable method with creditable short-term efficacy though the long-term effect still needed further research .