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目的 探讨缺血预处理 (IPC)对肝硬化肝癌患者入肝血流阻断肝切除的保护作用及其机理。 方法 将近期手术切除的 2 9例原发性肝癌 (HCC)随机分为 2组 :IPC组 (n =14 ) :肝门阻断切肝前先给予缺血 5min ,灌注 5min的缺血预处理 ;对照组 (n =15 ) :单纯肝门阻断切肝。比较 2组术前后肝功能的变化和肝灌注 1h时肝组织caspase 3活性和细胞凋亡的情况。 结果 术后 1、3、7d ,IPC组的天门冬氨酸氨基转移酶 (AST)、丙氨酸氨基转移酶 (ALT)明显低于对照组 (t =4 2 38,P <0 0 5 ) ;术后 3、7d ,IPC组的总胆红素 (TBIL)明显低于对照组 (t=2 2 96 ,P <0 0 5 ) ;术后 1d ,IPC组的ALB高于对照组 ,但无统计学差异 (t=2 0 2 9,P >0 0 5 )。术后 1h ,IPC组肝组织caspase 3活性和凋亡的内皮细胞均明显低于对照组 (t=2 349,P <0 0 5 )。 结论 IPC对肝硬化肝癌患者入肝血流阻断肝切除术后肝功能有良好的保护作用 ,其保护机理是通过抑制caspase 3的活性 ,从而抑制肝窦内皮细胞来实现的。
Objective To investigate the protective effect and mechanism of ischemic preconditioning (IPC) on hepatic resection by hepatic blood flow in cirrhotic patients with liver cancer. Methods Twenty-nine patients with primary hepatocellular carcinoma (HCC) who underwent surgical resection were randomly divided into two groups: IPC group (n = 14): ischemic preconditioning ; Control group (n = 15): simple hepatic portal vein occlusion. The changes of liver function before and after the operation and the activity of caspase 3 and the apoptosis of the hepatic tissue at 1 hour after hepatic perfusion were compared. Results Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in IPC group were significantly lower than those in control group at 1, 3 and 7 days after operation (t = 4238, P <0 05) . At 3 and 7 days after operation, the total bilirubin (TBIL) in IPC group was significantly lower than that in control group (t = 2 2 96, P 0 05). At 1 day after operation, the ALB level in IPC group was higher than that in control group No significant difference (t = 2 0 2 9, P> 0 0 5). At 1 h after operation, the activity of caspase 3 and the number of apoptotic endothelial cells in IPC group were significantly lower than those in control group (t = 2 349, P <0 05). Conclusion IPC has a good protective effect on hepatic function after hepatectomy and hepatic resection in cirrhotic patients with liver cirrhosis. The protective mechanism of IPC is through inhibiting the activity of caspase 3 and inhibiting the hepatic sinusoidal endothelial cells.