Treatment of liver cirrhosis by increase of hepatopetal portal flow using transcatheter occlusion of portosystemic shunt

从2005年4月到2007年3月，我们对53例胃静脉曲张患者进行了B-RTO手术。其中28例患者被纳入本研究。肝功能储备改善，定义为Child-Pugh评分系统降低1分以上，为42.9%。B-RTO后血清白蛋白升高有统计学意义。B-RTO后血清肝纤维化指标升高。尤其是B-RTO后III型前胶原肽和IV型胶原明显增加。B-RTO后HGF和VEGF无明显变化。B-RTO后肝脏体积增加60.7%。肝体积增大组有统计学意义。肝脏体积平均增加11.9%。肝脏体积最大增幅为31.1%。经简单回归分析，B-RTO后肝脏体积增加率与B-RTO前血清IV型胶原呈负相关。（y=-0.057x+18.113 p=0.001 r=-0.602）肝细胞癌患者行B-RTO后肝功能储备未加重。肝细胞癌患者术前透明质酸水平较高，B-RTO术后明显升高。肝纤维化指标术前平均较高，B-RTO后升高幅度更大，说明B-RTO后肝功能虽有所改善，但肝纤维化仍在进行中。然而，也有患者肝功能和腹水得到改善。这一结果表明，在有限的患者中，肝纤维化的进展受到抑制。综上所述，血清IV型胶原蛋白水平是术后肝体积增加的一个预测指标。

We have performed B-RTO, from April 2005 to March 2007, for total number of 53 patients with gastric varices. Among them, 28 patients were investigated for this study. Improvement of hepatic function reserve, which defined as reduction more than one point in the Child-Pugh scoring system, was 42.9%. Increase of serum albumin was statistically significant after B-RTO. Serum hepatic fibrosis markers increased after B-RTO. Especially, type III procollagen peptide and type IV collagen significantly increased after B-RTO. HGF and VEGF showed no change after B-RTO. Liver volume increased in 60.7% after B-RTO. Increased group of liver volume was statistically significant. The average increase of liver volume was 11.9%. The maximum increase rate of liver volume was 31.1%. The increase rate of liver volume after B-RTO showed inverse correlation with serum type IV collagen before B-RTO by simple regression methods. (y=-0.057x+18.113 p=0.001 r=-0.602) Liver function reserve did not aggravate in the patients with HCC who underwent B-RTO. Level, of hyaluronic acid of the patients with HCC revealed high preoperatively, and it elevated much more after B-RTO. Hepatic fibrosis markers revealed high in average preoperatively, and it elevated much more after B-RTO, it is interpreted that hepatic fibrosis is in progress although liver function improved after B-RTO. However, there are patients whose liver function and ascites improves. This result showed that the progress of hepatic fibrosis was suppressed in limited patients. In conclusion, serum type IV collagen level is a predictor of postoperative increase of liver volume.