奥曲肽在肝癌合并肝炎后肝硬化患者肝切除术中及围手术期的临床应用  

The intra- and postoperative using of octreotide in HCC patients with posthepatitic cirrhosis under went hepatectomy

作　　者：鲁岩[1] 郭立民[1] 李勤涛[1] 贾哲[1] 李宝亮[1] 蒋力[1] 

机构地区：[1]首都医科大学附属北京地坛医院外科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2014年第4期14-17,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市科委首都临床特色应用研究(No.Z121107001012169);首都医科大学附属北京地坛医院院内青年基金(No.QN2011-05)

摘　　要：目的探讨奥曲肽对于肝细胞癌(HCC)合并肝炎后肝硬化和门静脉高压患者,肝切除术中肝门阻断及术后应用对术后肝功能恢复的影响。方法回顾性研究94例HCC合并肝炎后肝硬化和门静脉高压症并实施了肝切除术的患者,其中25例术中至术后5 d内持续静脉泵入奥曲肽(25μg/h),作为治疗组,另外选取69例未应用奥曲肽的患者作为对照组。观察术中肝门阻断率、术中出血量、围手术期肝功能恢复情况及前白蛋白及其水平变化。结果治疗组术中肝门阻断率(60%)较对照组(82.61%)显著降低,差异具有统计学意义(χ2=5.233,P=0.022);两组患者出血量无统计学意义,术后第7天ALT、AST、TBil、腹水引流量治疗组均较对照组有明显恢复,差异具有统计学意义(ALT:t=-2.1443,P=0.0346;AST:t=-2.2193,P=0.0289;TBil:t=-2.2421,P=0.0274;腹水量:t=-3.0571,P=0.0029)。而两组间前白蛋白和ICG-R15水平差异无统计学意义。结论术中及围手术期应用奥曲肽,在相同术中出血量下可降低术中肝门阻断率,并显著改善术后肝功能,且不影响肝脏的合成功能,对于此类患者具有一定的临床应用价值。Objective To investigate the effect of octrcotide protecting liver fimction in hepatocellular carcinoma （HCC） patients with posthepatitic cirrhosis and portal hypertension （PHT） treated with liver resection and hepatic portal block during operation. Methods Total of 94 patients with HCC of posthepatitic cirrhosis and portal hypertension were analyzed, retrospectively. There were 25 patients in research group were continuously treated with octreotide （25 μg/h） through intravenous pump in postoperative 5 days. At the same time, 69 patients in control group were not used the octreotide. The rate of hepatic portal block, intraoperative blood loss and postoperative liver function recovery were observed and analyzed, respectively. Results The rate of hepatic portal block in research group was significantly lower than it in control group （60% vs 82.61%, x^2 = 5.233, P = 0.022）. There were no significant difference in blood loss in the two groups. The recover of ALT, AST, TBil and ascites in 5 days after operation were significantly quickly back to normal in research group compared with which in control group （ALT： t = -2.1443, P = 0.0346; AST： t = -2.2193, P = 0.0289; TBil： t = -2.2421, P = 0.0274; ascites： t = -3.0571, P = 0.0029）, while pre-albumin and ICG-R15 were with no difference in two groups. Conclusions The HCC patients with PHT are treated with octreotide in preand post-operative time could reduce the opportunities of hepatic portal block in liver resection, and which may be beneficial to liver function recovery after surgery.

关 键 词：肝细胞癌 门静脉高压症 肝炎后肝硬化 肝切除 肝门阻断 生长抑素 奥曲肽 

分 类 号：R735.7[医药卫生—肿瘤]