摘要
目的:探讨选择性肝门阻断联合逆行肝切除治疗巨大肝癌对健侧肝组织再灌注损伤、余肝功能的影响。方法:45例巨大肝癌(直径≥10 cm)患者按照Zelen设计的临床分组方案分为对照组和观察组,对照组行完全阻断第一肝门的顺行肝癌切除,观察组行选择性阻断第一肝门的逆行肝癌切除,两组均于肿瘤切除后留取少许健侧肝组织。检测两组患者术后1周总胆红素(TBIL)、谷丙转氨酶(ALT)、前白蛋白(PA)水平及健侧肝组织肝细胞凋亡情况、细胞内钙离子浓度([Ca2+]i)、丙二醛(MDA)含量、超氧化歧化酶(SOD)活性。结果:与对照组比较,观察组术后1周的ALT明显降低、PA含量明显升高(均P<0.05),而TBIL水平差异无统计学意义(P>0.05);健侧肝组织肝细胞凋亡水平、[Ca2+]i、MDA含量均明显下降,SOD活性明显增高(P<0.05)。结论:与传统方法比较,选择性第一肝门阻断逆行肝切除术治疗巨大肝癌更有利于减少健侧肝组织的再灌注损伤和保护余肝功能。
Objective： To investigate the influence of the anterior approach the reperfusion injury in the contralateral non-tumor liver tissue hepatectomy with selective inflow occlusion on and remnant liver function in treatment of huge hepatocellular carcinoma （HCC）. Methods： Forty-five patients with huge HCC （≥10 cm in diameter） were divided into observational group and control group using Zelen＇s single randomized consent design. Patients in control group underwent the conventional hepatectomy with total hepatic inflow occlusion, while those in observational group underwent anterior approach hepatectomy with selective inflow occlusion and a small contralateral non-tumor tissue specimen was taken from each patient in both groups after tumor removal. The levels of total bilirubin （TBIL）, alanine transaminase （ALT） and prealbumin （PA） in the two groups of patients at one week after surgerywere measured, and the apoptosis, and the parameters of intracellular calcium ion concentration （[Ca^2＋]i）, malondialdehyde （MDA） content and superoxide dismutase （SOD） activity in contralateral non-tumor tissues were also determined. Results： Compared with control group, the ALT release was decreased and PA level was increased significantly （both P〈0.05）, while the TRIL level showed no obvious difference （P〉0.05） at one week after surgery in observational group; the apoptosis, [Ca^2＋]i and MDA content was significantly reduced, while the SOD activity was significantly elevated in the contralateral non-tumor tissue in observational group （all P〈0.05）. Conclusion： Compared with conventional procedure, anterior approach hepatectomy with selective inflow occlusion for huge HCC is superior in reducing reperfusion injury of the contralateral non-tumor liver tissue and improving the function of remnant liver.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2014年第1期13-17,共5页
China Journal of General Surgery
关键词
肝肿瘤
外科学
肝切除术
再灌注损伤
肝功能检测
Liver Neoplasms/surg
Hepatectomy
Reperfusion Injury
Liver Function Tests
