选择性入肝血流阻断在左半肝切除术中的作用研究

摘要

Objective To analyze the effect of selective hemihepatic blood flow occlusion on easing hepatic ischemia-reperfusion injury. Methods Sixty-eight cases of hepatocellular carcinoma who received left hepatectomy were randomly divided into observation group and control group, each with 34 cases. The patients of the control group received Pringle occlusion, the patients of the observation group underwent selective hemihepatic blood flow occlusion. Liver function, lipid peroxidation and inflammatory indexes were compared between the two groups before blocking (T0) and 20 min after recovery of liver blood flow (T1). Results Compared with the control group, the content of ALT, AST, ALP, γ-GT, XOD, MDA, MPO, IL-1β, IL-8 and TNF-α was lower, SOD and GSH-Px content was relatively higher in the observation group. The change trends of ALT, AST, ALP, γ-GT, XOD, MDA, MPO, SOD, GSH-Px, IL-1β, IL-8 and TNF-α content of the two groups were different (P < 0.05). Conclusions Selective hemihepatic blood flow occlusion can reduce ischemia-reperfusion injury during left hemihepatectomy, promote postoperative liver function, and improve homeostasis recovery.%目的 分析选择性入肝血流阻断在减轻左半肝切除术中肝脏缺血再灌注损伤方面的作用.方法 肝癌行左半肝切除术治疗的患者随机分为观察组及对照组,对照组患者接受Pringle阻断法,观察组患者接受选择性左半肝入肝血流阻断,对比两组患者的阻断前和恢复肝血流后20 min肝功能、脂质过氧化及炎症因子等缺血再灌注相关指标差异.结果 两组丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(γ-GT)、黄嘌呤氧化酶(XOD)、丙二醛(MDA)、髓过氧化物酶(MPO)、白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)及谷胱甘肽过氧化物酶(GSH-Px)比较有差异(P<0.05);两组ALT、AST、ALP、γ-GT、XOD、MDA、SOD、GSH-Px、MPO、IL-1β、IL-8及TNF-α 含量的变化趋势比较有差异(P<0.05).结论 选择性入肝血流阻断可减轻左半肝切除术中的肝脏缺血再灌注反应,促进患者术后肝功能提升和内环境稳态恢复.