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目的:探讨血流阻断的缺血预处理技术在肝癌切除术中的临床应用价值。方法:选取2010年4月至2013年7月我院收治的96名原发性肝癌并采用肝脏部分切除术进行治疗的患者,将患者随机分为观察组和对照组,每组各48例,观察组在肝脏部分切除术阻断肝门血流前先分别给予1个5 min缺血和再灌注的处理。对照组不采取任何干预措施。术前、术后1天、3天、7天时分别进行生化检查,并于术前及术后1h对Fas-mRNA表达、Caspasc-3活性及AI进行测定,观察记录患者术后的并发症情况、手术时间、术中出血量以及住院时间。结果:术后1天、3天、7天时两组间的AST、ALT、TBIL等生化指标的含量情况相比,观察组均显著优于对照组(P<0.05);术后l d,两组患者ALB均有不同程度的降低,对照组低于观察组(P<0.05);术后住院时间观察组为13.28±3.85天,对照组为19.48±4.92天,观察组明显低于对照组(P<0.05);术后1h,两组患者的Fas-mRNA表达、Caspasc-3活性相比于阻断前均显著提高,但观察组提高幅度明显低于对照组,差异有统计学意义(P<0.05);两组阻断前均未见肝细胞凋亡,术后l h时,两组组均可见肝细胞凋亡,且对照组明显高于观察组组(P<0.05)。结论:血流阻断的缺血预处理技术具有操作简便、副作用小的重要特点,应用于肝癌切除术中在保护肝功能方面具有显著的优势。
Objective: To investigate the clinical value of ischemic preconditioning with blood flow in hepatectomy. Methods: A total of 96 primary hepatocellular carcinoma (HCC) patients treated in our hospital from April 2010 to July 2013 were selected and treated with partial hepatectomy. The patients were randomly divided into observation group and control group, with 48 cases in each group. The observation group was given a 5-min ischemia and reperfusion treatment before partial hepatectomy blocked the hepatic portal flow. The control group did not take any interventions. The biochemical tests were performed before, 1 day, 3 days and 7 days after operation. Fas-mRNA expression, Caspase-3 activity and AI were measured before and 1 hour after surgery. The postoperative complications were observed and recorded , Operation time, intraoperative blood loss and hospitalization time. Results: Compared with the control group (P <0.05), the observation group were significantly better than the control group on the 1st, 3rd, and 7th day after operation (P <0.05) (P <0.05). The length of postoperative hospital stay was 13.28 ± 3.85 days and the control group was 19.48 ± 4.92 days, the observation group was significantly lower than the control group (P <0.05). At 1 hour after operation, Fas-mRNA expression and Caspase-3 activity in both groups were significantly increased compared with that before the interruption, but the improvement in the observation group was significantly lower than that in the control group (P < 0.05). No apoptosis of hepatocytes was observed in both groups before and after the operation. The apoptosis of hepatocytes was observed in both groups at 1 hour after operation, and was significantly higher in the control group than in the observation group (P <0.05). Conclusion: The ischemic preconditioning technique with blood flow blocker has the important features of simple operation and small side effects. It has significant advantages in the protection of liver function in liver cancer resection.