摘要
目的 探讨临床上施行复杂的肝脏部分切除手术前 ,增加肝细胞内糖原含量能否减轻术中因阻断肝血流所带来的肝脏缺血 -再灌注损伤及其相关机制。方法 将近 3年收治的临床基本情况相近的 17例病人分为实验组及对照组。实验组于术前 2 4h内静脉滴注 2 5 %葡萄糖 2 5 0mL ,共 4次 (每 6h 1次 ) ;对照组不作特殊处理。两组病人均采用阻断第一肝门方法行病变肝脏切除术。术中分别于肝脏缺血前、缺血后及再灌注 1h ,获取相对正常的肝组织测定组织中ATP含量及肝细胞膜Na+ K+ ATP酶、Ca2 + ATP酶活性 ;此外于术前及术后第1、5天 ,抽取血液标本 ,检测病人肝功能情况。结果 两组病人于缺血后及再灌注 1h时 ,实验组肝组织ATP含量及肝细胞膜Na+ K+ ATP酶、Ca2 + ATP酶活性均显著高于对照组 (P <0 0 1) ;术后第 1、5天 ,实验组肝功能改善程度均显著优于对照组 (P <0 0 1) ,而术前两组间则差异无显著性。结论 临床上在阻断肝脏血流施行复杂的肝脏手术之前 ,增加肝细胞内糖原含量可有效地减轻肝脏缺血 -再灌注损伤程度 。
Objective To study the effect and mechanism of intracellular glycogen on liver ischemia-reperfusion injury from hepatic vascular exclusion.Methods 17 patients were divided into experiment group(n=9) and control group(n=8).The patients of experiment group were injected with 250mL of 25% glucose via vein per 6 hours during pre-operative 24 hours.The pathological liver tissue were resected by using portal triad clamping in the two groups.Hepatic tissue were biopsied to measure hepatic tissue ATP contents and activities of membrane Na + K + ATPase and Ca 2+ ATPase at the point of pre-ischemia,post-ischemia and reperfusion 1 hour.Furthermore,live function of all patients were investigated at the point of pre-operation and post-operative 1 and 5 days.Results Both hepatic tissue ATP contents and activities of membrane Na + K + ATP ase and Ca 2+ ATP ase from experiment group were significantly higher than those of control group at the point of post-ischemia or reperfusion 1 hour(P<0 01).Besides,liver function of experiment group were significantly better than that of control group at the post-operative 1 and 5 day(P<0 01).On the contrary,there was no difference between the two groups during pre-operation.Conclusion Before liver blood flow is obstructed in order to perform complex liver operation,intracellular abundant glycogen may reduce liver ischemia-reperfusion injury caused by hepatic vascular exclusion.
出处
《中国实用外科杂志》
CSCD
北大核心
2001年第6期350-352,共3页
Chinese Journal of Practical Surgery
关键词
肝细胞糖原
肝脏手术
肝缺血
再灌注损伤
Liver glycogen Hepatic operation Ischemia-reperfusion injury
