肝硬化肝细胞癌患者行大范围肝切除术后的护肝药物临床应用分析  

Analysis of Strategy of Hepatoprotective Drugs Administration in Cirrhotic Patients with Hepatocellular Carcinoma Underwent Major Liver Resection

作　　者：刘淑君 王经琳 刘金春 任昊桢[1,4] 杜瑶 葛卫红[1,2,3] 陈大宇 LIU Shujun;WANG Jinglin;LIU Jinchun;REN Haozhen;DU Yao;GE Weihong;CHEN Dayu(Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Pharmacy;Nanjing Medical Center for Clinical Pharmacy;Division of Hepatobiliary and Transplantation Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京中医药大学中西医结合鼓楼临床医学院,南京210008 [2]南京大学医学院附属鼓楼医院药学部 [3]南京大学医学院附属鼓楼医院南京临床药学中心 [4]南京大学医学院附属鼓楼医院肝胆与肝移植外科,南京210008

出　　处：《药学与临床研究》2023年第3期225-229,共5页Pharmaceutical and Clinical Research

基　　金：国家自然科学基金(82100664);南京大学医院管理研究所课题项目;南京鼓楼医院医学发展医疗救助基金会资助项目(NDYG2020052);南京临床医学中心建设项目(宁卫科教[2020]1号)

摘　　要：目的:分析肝硬化肝细胞癌患者行大范围肝切除术后护肝药物的临床应用情况。方法:纳入2020年1月~2022年6月南京大学医学院附属鼓楼医院肝胆胰中心收治入院的肝癌肝硬化并接受大范围肝切除手术的患者,针对用药方案的临床应用进行分析。结果:共纳入128例患者,术后单用护肝药物者67例(52.3%),联合使用两种护肝药物者58例(45.3%),联合使用三种护肝药物者3例(2.3%)。联合用药的患者手术时间以及术中肝门阻断时间均较单药治疗组长,腹腔镜手术的比例较低,预计剩余肝脏体积百分比较小,术中输血量较大,术后第1天谷丙转氨酶水平也较高。发生肝切除术后肝功能衰竭者共40例,联合使用护肝药物的患者发生率较高,但B级和C级肝功能衰竭的发生率与单药治疗组相比,差异无统计学意义。单药治疗与联合使用护肝药物治疗的患者相比,虽然胸、腹腔积液的发生率更低,但术后感染性并发症的发生率更高。结论:对于肝硬化肝细胞癌行大范围肝切除的患者,联合用药可能增加胸腹腔积液的发生风险,但是可以减少感染性并发症,改善预后。Objective:To analyze the clinical use of hepatoprotective drugs in cirrhotic patients with hepatocellular carcinoma underwent major liver resection.Methods:Cirrhotic patients with hepatocellular carcinoma underwent major hepatectomy,who were admitted to the Hepatobiliary and Pancreatic Center of Drum Tower Hospital Affiliated to Nanjing University School of Medicine from January 2020 to June 2022,were included.Retrospective assessment of treatment efficacy was carried out.Results:A total of 128 patients were finally included.Monotherapy was used in 67 patients(52.3%).Combined use of two drugs was observed in 58 patients(45.3%)and triple therapy was utilized in 3 patients(2.3%).Prolonged length of surgery and time of hepatic inflow occlus,higher proportion of open abdomen surgery,smaller predicted remnant liver volume,larger amount of blood infusion during surgery and higher level of alanineaminotransferase after surgery were observed in patients received polytherapy.Post-hepatectomy liver failure occurred in 40 patients,who were more under polytherapy.For the post-hepatectomy liver failure classified as rank B or rank C,no significant differences were observed between the drug use groups.Proportions of hydrothorax and ascites were lower in the monotherapy group while more infectious complications were observed.Conclusion:Cirrhotic patients with hepatocellular carcinoma undergoing major hepatectomy may benefit from polytherapy of hepatoprotective drugs by lowering the proportion of infectious complications,but may increase the chance of hydrothorax and ascites.

关 键 词：肝硬化 肝癌 大范围肝切除 肝衰竭 联合用药 护肝药物 

分 类 号：R969.3[医药卫生—药理学]