兔半肝切除术前后甲状腺激素、胰岛素及甲胎蛋白的监测研究  

MONITORING OF THYROXIN,INSULIN AND α-FETOPROTEIN ON PRE AND POSTOPERATIVE HEMIHEPATECTOMY OF EXPERIMENTAL RABBITAS

作　　者：尉继伟[1] 计学理[1] 周正忠[1] 吉喆[1] 刘治邦[1] 耿建[1] 

机构地区：[1]北京铁路局大同铁路中心医院,大同037005

出　　处：《肝胆外科杂志》2002年第4期312-314,共3页Journal of Hepatobiliary Surgery

摘　　要：目的　探讨左半肝切除对血清甲状腺激素、胰岛素及甲胎蛋白的影响、病理过程。方法　手术切除兔左半肝脏 ,分别于术前 1d、术后 2 4 h、术后 4 8h、术后 1周、术后 1月取外周静脉血 ,监测血清甲状腺激素、胰岛素及甲胎蛋白的变化。结果　甲状腺激素 TT3、TT4 术后 2 4 h明显降低 ,术后 4 8h、术后 1周逐渐回升 ,TT3较 TT4 回升幅度大 ,术后 1月二者接近术前水平 ;胰岛素术后明显升高 ,术后 1周逐渐下降 ,术后 1月近术前水平 ;甲胎蛋白在术后 4 8h明显升高 ,术后 1周达最高峰 ,以后渐降 ,术后 1月下降明显、但仍高于术前水平。结论　肝切除术后出现非甲状腺疾病综合征 ,与 5′——脱碘酶和血浆蛋白降低有关 ;同时出现高胰岛素反应 ,血糖上升刺激胰岛分泌胰岛素、肝胰岛素受体最大结合容量减少、肝脏灭活胰岛素能力下降均可使胰岛素水平高于术前水平 ;甲胎蛋白的变化与术后肝脏旺盛的修复再生有关 。Objective To evaluate the effect and pathological process on serum thyroxin,insulin and α fetoprotein by hemihepatectomy.Methods The left hemihepatectomy were carried out in the experimental rabbits,the peripheral venous blood samples were drawnpre and postoperatvely.The levels and the changes of serum thyroxin,insulin significantly decreased on the 24 hour postoperatively,they returned gradually on the 48 hour and the first week after operation.The raised degree of TT 3 was higher than of TT 4,both of them approached the same level of preoperative measurement in the first month.The level of insulin obviously increasedand returned to the preoperative level.The measurement of α fetoprotein evidently rised on the 48 hour after operation,and resched the highest level on the first week.Afterwards,it gradually decreased and reached the lowest level on the first month postoperatively,but it still was higher than its level preoperatively.Conclusion The syndrome of nonthyroid disease after hemihepatectomy is contributed to the reduced serum 5'-deiodinase and serum albumin as well as the reaction of hyperinsulinemia.The hyperglycosemia stimulats the secretion of islet cell,the receptors of inlet cell decrease its maximum integration volume,the liver capacity of inactivation of insulin descende,all these could make the level of insulin lower than its preoperative level.The change of α-fetoprotein is associated with the enhancement of repairment and regeneration of liver,but the higher α fetoprotein level might relate to the experimental animal species.

关 键 词：肝切除 甲状腺激素 胰岛素 甲胎蛋白 监测 

分 类 号：R657.3[医药卫生—外科学]