不同入路下行左肝外叶切除术对机体创伤应激反应程度及残余肝功能影响
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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 2 d after operation were significantly lower than those in A group.Blood glucose at 1 d after operation were lower than those in A group.1 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.
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 2 d after operation were significantly lower than those in A group.Blood glucose at 1 d after operation were lower than those in A group.1 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.
引文
[1]杨红霞,王振全.肝脏左外叶肝癌破裂出血误诊为急性冠状动脉综合征.临床误诊误治,2016,29(11):19-20.
[2]邓军,曾朝霞,黄小宁,等.门静脉高压镰状韧带上组静脉分流的MSCT表现.临床放射学杂志,2016,35(1):55-58.
[3]张健飞,郑楠,宫瑾,等.人肝脏分段分色血管铸型透明标本制作.中国临床解剖学杂志,2015,33(4):494-495.
[4]杨明坤.肝圆韧带入路的解剖性肝切除术.西南国防医药,2014,24(9):964-966.
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[7]吴泓,谢坤林,黄纪伟,等.经肝圆韧带裂入路肝切除术的临床疗效.中华消化外科杂志,2016,15(1):53-57.
[8]孙颢,陈佳栋,高友福,等.肝圆韧带在腹腔镜上消化道穿孔手术中的应用.中国现代普通外科进展,2016,19(4):316-317.
[9]刘天锡,方登华,关斌颖,等.腹腔镜经左纵沟入路解剖性左肝切除的临床应用.中华普通外科杂志,2015,30(7):520-524.
[10]吴振宇,胡浩,金昌国,等.不同入路腹腔镜肝切除术29例临床应用.中国内镜杂志,2015,21(6):657-660.
[11]沈锋,张小峰.原发性肝癌肝切除术质量控制若干问题.中国实用外科杂志,2016,36(1):11-14.
[12]霍明生,鲁正,崔培元,等.肝动脉变异在肝门淋巴结廓清中的临床意义.中国肿瘤临床,2015,42(1):61-65.
[13]蔡翊,易为民.腹腔镜下左肝外叶切除治疗肝胆管结石30例临床体会.医学临床研究,2015,32(9):1826-1827.
[14]胡越,熊威威,谭毅,等.不同急性应激反应大鼠模型的比较.中国比较医学杂志,2016,26(12):51-54.
[15]冯曼玲.家属的护理干预对脑胶质瘤患者围手术期应激状态的影响.标记免疫分析与临床,2014,21(5):553-556.
[16]中华医学会麻醉学分会.围术期血糖管理专家共识(快捷版).临床麻醉学杂志,2016,32(1):93-95.
[17]易波,陈迅,唐才喜.CT引导穿刺引流联合经皮肾镜治疗急性重症胰腺炎合并胰周组织坏死的疗效.医学临床研究,2015,32(4):675-677.
[18]袁兴娅,熊海,甘华田.肝豆状核变性合并肝脏损害的临床误诊分析.成都医学院学报,2015,10(4):452-454.
[19]张黎黎,刘爱东,蒲春华,等.替米沙坦减轻DOCA-盐型高血压大鼠氧化应激改善血管内皮功能研究.成都医学院学报,2015,10(1):44-48.
[20]王晓明,王翠娟,景邵春,等.维生素D缺乏的糖耐量正常男性血清中MDA、T-Aoc、H2O2、25(OH)D3水平与胰岛素抵抗的关系.医学临床研究,2015,32(11):2114-2116.
[21]张梓楠,冯莹,曹惠芳,等.谷胱甘肽过氧化物酶与脂质过氧化物在哮喘发病前后变化及意义.西部医学,2015,27(1):78-79.
[22]张璞,任路平,张雪梅,等.高果糖喂养致小鼠脂肪肝与肝脏氧化应激的时程变化.解放军医药杂志,2016,28(3):5-8.
[23]赵晓彪,明玉玲,陈平.肝切除术后肝脏再生的研究进展.解放军医学杂志,2014,39(1):70-74.
[2]邓军,曾朝霞,黄小宁,等.门静脉高压镰状韧带上组静脉分流的MSCT表现.临床放射学杂志,2016,35(1):55-58.
[3]张健飞,郑楠,宫瑾,等.人肝脏分段分色血管铸型透明标本制作.中国临床解剖学杂志,2015,33(4):494-495.
[4]杨明坤.肝圆韧带入路的解剖性肝切除术.西南国防医药,2014,24(9):964-966.
[5]IBUKURO K,TAKEGUCHI T,FUKUDA H,et al.Spatial anatomy of the round ligament,gallbladder,and intrahepatic vessels in patients with right-sided round ligament of the liver.Surgical&Radiologic Anatomy,2016,38(9):1061-1067.
[6]江涛,何谦,张诚华,等.肝细胞癌伴肝硬化门静脉高压患者肝切除术可行性研究.临床误诊误治,2015,28(2):98-102.
[7]吴泓,谢坤林,黄纪伟,等.经肝圆韧带裂入路肝切除术的临床疗效.中华消化外科杂志,2016,15(1):53-57.
[8]孙颢,陈佳栋,高友福,等.肝圆韧带在腹腔镜上消化道穿孔手术中的应用.中国现代普通外科进展,2016,19(4):316-317.
[9]刘天锡,方登华,关斌颖,等.腹腔镜经左纵沟入路解剖性左肝切除的临床应用.中华普通外科杂志,2015,30(7):520-524.
[10]吴振宇,胡浩,金昌国,等.不同入路腹腔镜肝切除术29例临床应用.中国内镜杂志,2015,21(6):657-660.
[11]沈锋,张小峰.原发性肝癌肝切除术质量控制若干问题.中国实用外科杂志,2016,36(1):11-14.
[12]霍明生,鲁正,崔培元,等.肝动脉变异在肝门淋巴结廓清中的临床意义.中国肿瘤临床,2015,42(1):61-65.
[13]蔡翊,易为民.腹腔镜下左肝外叶切除治疗肝胆管结石30例临床体会.医学临床研究,2015,32(9):1826-1827.
[14]胡越,熊威威,谭毅,等.不同急性应激反应大鼠模型的比较.中国比较医学杂志,2016,26(12):51-54.
[15]冯曼玲.家属的护理干预对脑胶质瘤患者围手术期应激状态的影响.标记免疫分析与临床,2014,21(5):553-556.
[16]中华医学会麻醉学分会.围术期血糖管理专家共识(快捷版).临床麻醉学杂志,2016,32(1):93-95.
[17]易波,陈迅,唐才喜.CT引导穿刺引流联合经皮肾镜治疗急性重症胰腺炎合并胰周组织坏死的疗效.医学临床研究,2015,32(4):675-677.
[18]袁兴娅,熊海,甘华田.肝豆状核变性合并肝脏损害的临床误诊分析.成都医学院学报,2015,10(4):452-454.
[19]张黎黎,刘爱东,蒲春华,等.替米沙坦减轻DOCA-盐型高血压大鼠氧化应激改善血管内皮功能研究.成都医学院学报,2015,10(1):44-48.
[20]王晓明,王翠娟,景邵春,等.维生素D缺乏的糖耐量正常男性血清中MDA、T-Aoc、H2O2、25(OH)D3水平与胰岛素抵抗的关系.医学临床研究,2015,32(11):2114-2116.
[21]张梓楠,冯莹,曹惠芳,等.谷胱甘肽过氧化物酶与脂质过氧化物在哮喘发病前后变化及意义.西部医学,2015,27(1):78-79.
[22]张璞,任路平,张雪梅,等.高果糖喂养致小鼠脂肪肝与肝脏氧化应激的时程变化.解放军医药杂志,2016,28(3):5-8.
[23]赵晓彪,明玉玲,陈平.肝切除术后肝脏再生的研究进展.解放军医学杂志,2014,39(1):70-74.