肝移植改善肝性脊髓病症状的远期评价
Evaluation of long-term therapeutic efficiency of liver transplantation in patients with hepatic myelopathy
目的 探讨肝移植对改善终末期肝病患者肝性脊髓病(HM)症状的效果.方法 回顾性分析17例接受肝移植手术的终末期肝病合并HM患者的临床资料.随访期限为50个月(13~106个月).对肝移植前后患者的双下肢肌力、血常规和生化指标以及双下肢活动情况进行分析.结果 肝移植术后8周内,所有患者的血常规、生化指标等均基本恢复正常.术后4周内血氨均恢复正常,平均值为44.1μmol/L.截至随访期末,17例患者的双下肢肌力均有改善,其中15例肌力恢复正常,2例肌力恢复也超过2个级别,其中由Ⅳ级恢复到Ⅴ级3例(17.6%),由Ⅲ级恢复到Ⅴ级8例(47.1%),由Ⅱ级恢复到Ⅴ级4例(23.5%),由工级恢复到Ⅳ级1例(5.9%),由Ⅰ级恢复到Ⅲ级1例(5.9%).术前9例无法站立的患者中,术后1例能恢复自主行走,7例恢复到辅助行走,1例仍无法站立,但肌力由Ⅰ级恢复到Ⅲ级;术前2例可站立的患者术后均恢复到辅助行走;术前3例辅助行走的患者术后均恢复到自主行走;3例自主行走肌力也完全恢复正常.结论 终末期肝病合并HM患者在肝移植术后远期,HM症状得到明显改善.HM的预后与其术前本身的进展程度有关,在出现下肢活动异常前接受肝移植治疗的患者,其HM预后较好.
更多Objective To investigate the long-term efficacy of orthotopic liver transplantation (OLT) in patients with hepatic myelopathy (HM).Method The clinical data of 17 patients with hepatic myelopathy,who underwent OLT,were retrospectively analyzed.The follow-up period was 13-106 months (mean 50 months).The muscle strength of two lower limbs,the blood routine examinations and other biochemical indexes,and the ability to walk were assessed before and after operation.Result The blood routine examination and other biochemical indexes were normal at 8th weeks after OLT.The muscle strength of two lower limbs was increased after OLT.Fourteen cases recovered completely.As to the ability to walk,it was greatly different among patients.Seven patients could walk independently and 9 patients could walk with help.Only 1 could not stand so far.Conclusion The efficiency of liver transplantation in patients with HM should be affirmed.The prognosis of HM is related to conditions of patients before operation,and OLT was an effective way for treatment of patients with HM before paralysis.
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