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

自2005年4月至2007年3月，我们对53例胃静脉曲张患者进行了B-RTO。其中，28例患者接受了本研究的调查。肝功能储备的改善，定义为Child-Pugh评分系统中减少一分以上，为42.9%。B-RTO后血清白蛋白升高有统计学意义。B-RTO后血清肝纤维化标志物升高。尤其是III型前胶原肽和IV型胶原在B-RTO后显著增加。B-RTO后肝细胞生长因子和血管内皮生长因子无明显变化。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%。肝脏体积最大增加率为31.1%。一元回归分析显示，B-RTO后肝体积增加率与B-RTO前血清IV型胶原呈负相关。（y=-0.057x+18.113 p=0.001 r=-0.602）肝癌患者行B-RTO后肝功能储备未加重。HCC患者术前血清透明质酸水平较高，B-RTO后明显升高。肝纤维化指标术前平均值较高，B-RTO后升高更明显，说明尽管B-RTO后肝功能改善，但肝纤维化仍在进行中。然而，也有患者的肝功能和腹水改善。这一结果表明，在有限的患者中，肝纤维化的进展受到抑制。总之，血清IV型胶原水平是术后肝体积增加的预测因子。

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.