缺血预处理在原发性肝癌切除手术中的应用  

Clinical application of ischemic preconditioning on patients with primary hepatic carcinoma underging hepatectomy

作　　者：吕新生[1] 胡国璜[1] 李小刚[1] 

机构地区：[1]中南大学湘雅医院普通外科,湖南长沙410008

出　　处：《中国普通外科杂志》2004年第9期679-681,共3页China Journal of General Surgery

摘　　要：目的　探讨缺血预处理 (IP)对原发性肝癌 (PHC )患者 ,在阻断肝门下行肝癌切除术后的肝缺血再灌注损伤的保护作用。方法　将在阻断肝门下行肝癌切除术的 62例PHC患者随机分为对照组 (C组 )和IP组。比较两组手术前后的血清转氨酶 (ALT ,AST)、乳酸脱氢酶 (LDH )和形态学变化 ,以及术中失血量、术后并发症、手术死亡率和住院时间。结果　 (1)术中失血量、术后并发症、手术死亡率和平均住院时间两组间无显著差异 (均P >0 .0 5 ) ;(2 )手术后血清ALT ,AST和LDH值IP组明显低于C组 (分别为P >0 .0 1,P >0 .0 1,P >0 .0 5 ) ;(3 )光镜及电镜下IP组的肝损伤程度较C组明显减轻。结论　阻断肝门下行肝癌切除时 ,采用IP可有效减轻肝的缺血再灌注损伤。Objective To study the effect of ischemic preconditioning(IP) on protecting ischemia-reperfusion(I-R) injury of the liver in patients with primary hepatic carcinoma(PHC) .Methods Sixty-two patients with PHC undergoing hepatectomy under hepatic inflow occlusion were randomly divided into 2 groups:(1) I-R group;(2)IP group.The serum concentretion of ALT,AST,and LDH,the morphology,and the intraoperative blood loss,postoperative complications,mortality and hospital stay of the two groups were examined and compared.Results (1)Intraoperative blood loss,postoperative complications,mortality and hospital stay between IP group and I-R group showed no significant differences(all P>0.05).(2)Serum ALT,AST and LDH:After reperfusion,the values of ALT,AST,and LDH in IP group were significantly lower than those in I-R group(P<0.001,P<0.001,P< 0.05,represpectively).(3)The morphological changes on microscopy and electron microscopy in IP group were significantly milder than those in I-R group.Conclusions IP is a simple and effective method for protecting the liver against I-R injury during hepatectomy clinically.

关 键 词：肝肿瘤/外科学 肝切除术 缺血预处理 肝缺血再灌注损伤 

分 类 号：R735.7[医药卫生—肿瘤] R657.3[医药卫生—临床医学]