摘要
目的探讨不同入路下行左肝外叶切除术对机体创伤应激反应、残余肝功能影响。方法以我院肝胆外科收治的85例行左肝外叶切除术患者为研究对象,根据手术入路不同分为经第一肝门入路组(A组,40例)与经肝圆韧带裂入路组(B组,45例),比较两组手术情况,包括手术时间、术中出血量、术后住院时间及并发症,并检测术前、术后1d、术后2d及术后3d各时间点的创伤应激指标肾上腺素、皮质醇(Cor)、降钙素原(procalcition,PCT)及血糖,并检测同时间点氧化应激指标总抗氧化能力(T-AOC)、氧化型谷胱甘肽(GSSG)、丙二醛(MDA)及超氧化物歧化化物歧化酶(SOD)水平,观察术前肝功能及术后残余肝功能情况。结果 A组手术时间明显短于B组,但出血量显著高于B组,差异具有统计学意义(P<0.05),两组术后住院时间、术后并发症发生率比较差异均无统计学意义(P>0.05);B组肾上腺素、Cor及PCT水平在术后1d、术后2d均明显低于A组,术后1d血糖均低于A组;术后1d,B组T-AOC、SOD水平高于A组,术后1d、术后2d、术后3d各时间点,MDA、GSSG水平明显低于A组,组间差异均具有统计学意义(P<0.05);两组肝功能ALB、HGF较术前明显上升,TBIL、AST、ALT明显下降(P<0.05),术后B组HGF明显高于A组,但其他指标组间比较差异均无统计学意义(P>0.05)。结论经肝圆韧带裂入路较经第一肝门入路左肝外叶切除相比,手术耗时虽长,但出血量小,机体创伤应激反应小,且显著减轻肝脏氧化应激反应,有效保护残余肝功能,促进术后肝功能恢复。
Objective To investigate the effect of different approaches of hepatic left lateral lobectomy on traumatic stress response and residual liver function in patients. Methods 85 cases of patients treated by hepatic left lateral lobectomy in the department of hepatobiliary surgery in our hospital were enrolled in the study. According to different surgical approaches, the patients were divided into the first hepatic portal approach group （ A group, n = 40 ） and ligamentum teres hepatic approach group （ B group, n -- 45 ）. The operation time ,intraoperative blood loss, postoperative hospitalization time and complications were compared between these two groups. The traumatic stress indexes such as epinephrine, cortisol （Cor）, procalcition （PCT） and blood glucose were detected at different time points. Levels of oxidative stress indicators such as total antioxidant capacity （ T- AOC ）, oxidized glutathione （ GSSG ）, malondialdehyde （ MDA ） and superoxide dismutase（SOD） were also detected at different time points. The liver function was observed before and after operation. Results The operation time of A group was significantly shorter than that of B group, while the blood loss was significantly higher than that in B group （ P 〈 0.05 ）. There were no significant difference between the two groups in postoperative hospitalization time and complications （ P 〉 0. 05 ）. Levels of epinephrine, Cor and PCT in B group at 1 d and 2d after operation were significantly lower than those in A group. Blood glucose at l d after operation were lower than those in A group, l d after operation, levels of T-AOC and SOD in B group were higher than those in A group, while levels of MDA and GSSG were significantly lower than those in A group at different time points （ P 〈 0.05 ）. After treatment, liver function indexes （ALB, HGF）in two groups were significantly increased while TBIL, AST and ALT were significantly decreased（ P 〈 0.05 ）. After operation, HGF in B group was significantly higher than that in A group, but there was no significant difference in other indicators （ P 〉 0.05 ）. Conclusion Compared with the first hepatic portal approach, although the time of ligamentum teres hepatic approach is long, the blood loss is less and traumatic stress response is milder. Ligamentum teres hepatic approach hepatic left lateral lobectomy can significantly reduce liver oxidative stress, effectively protect the residual liver function and promote the recovery of liver function after operation.
出处
《标记免疫分析与临床》
CAS
2018年第1期44-49,共6页
Labeled Immunoassays and Clinical Medicine
关键词
肝切除
创伤应激反应
肝功能
左肝膈面
肝圆韧带裂
Hepatectomy
Traumatic stress response
Liver function
Left diaphragmatic surface
Ligamentum teres hepatic
