肝癌切除术中选择性入肝血流阻断对肝脏缺血再灌注损伤的影响

摘要

Objective:To study the effect of selective hepatic inflow occlusion during liver cancer resection on liver is-chemia-reperfusion injury.Methods:A total of 68 patients with primary liver cancer who underwent left liver resection in our hospital between May 2012 and August 201 5 were selected for study and divided into group A (selective hepatic inflow occlu-sion of left liver)and group B (Prignle hepatic inflow occlusion)according to different intraoperative blood occlusion methods, serum was collected before and after operation to determine liver enzyme content,the removed liver tissue was collected to de-termine energy metabolism indexes,inflammation indexes and oxidative stress indexes.Results:1 d,3 d and 5 d after opera-tion,GPT,GOT,GGT,LDH and ALP content in serum of both groups were significantly higher than those before operation, and GPT,GOT,GGT,LDH and ALP content in serum of group A 1 d,3 d and 5 d after operation were significantly lower than those of group B;ATP,ADP,AMP,PI3K,AKT,GSK3β,T-AOC,PrxI and Trx content in liver tissue of group A were significantly higher than those of group B while PTEN,IL-12p40,MDA and MPO content were significantly lower than those of group B.Conclusions:Selective hepatic inflow occlusion during liver cancer resection can reduce the liver ischemia-reperfusion injury,improve the energy metabolism of liver cells and inhibit inflammation and oxidative stress in liver tissue.%目的：：研究肝癌切除术中选择性入肝血流阻断对肝脏缺血再灌注损伤的影响。方法：选择2012年5月~2015年8月期间在陕西省安康市汉滨区第一医院接受左半肝切除术的原发性肝癌患者68例进行研究,根据术中血流阻断方法不同分为 A 组(选择性左半肝入肝血流阻断)和 B 组(Prignle 法入肝血流阻断),手术前后分别测定血清中肝酶含量,另取切除的肝脏组织并测定能量代谢指标、炎症反应指标、氧化应激指标。结果：手术后1 d、3 d、5 d 时,两组患者血清中 GPT、GOT、GGT、LDH、ALP 的含量均显著高于手术前且 A 组患者术后1 d、3 d、5 d 时的血清 GPT、GOT、GGT、LDH、ALP 含量显著低于 B 组；A 组患者肝脏组织中 ATP、ADP、AMP、PI3K、AKT、GSK3β、T-AOC、PrxI、Trx 的含量显著高于 B 组,PTEN、IL-12p40、MDA、MPO 的含量显著低于 B 组。结论：肝癌切除术中选择性入肝血流阻断能够减轻肝脏缺血再灌注损伤,改善肝细胞能量代谢、抑制肝脏组织中的炎症反应和氧化应激反应。