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首页> 中文期刊> 《中华消化外科杂志》 >Pringle法导致的肝脏缺血再灌注损伤对肝癌肝切除患者预后的影响

Pringle法导致的肝脏缺血再灌注损伤对肝癌肝切除患者预后的影响

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摘要

Objective To evaluate the influence of hepatic ischemia-repeffusion injury (HIRI) induced by Pringle maneuver on the prognosis of hepatoceUular carcinoma (HCC) patients after hepatectomy. Methods The chnical data of 315 HCC patients who had been admitted to Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed. The 194 patients who received Pringle maneuver during hepatectomy were in the HIRI group. The control group was composed of 121 patients without portal triad clamping. The pre- and peri-operative characteristics and the prognosis of the patients were analyzed by t test, chi-square test, Kaplan-Meier survival curve, Log-rank test and Cox regression model analysis. Results Patients in the HIRI group were significantly younger than those in control group (median age, 49 vs 59) (X2 =4. 12, P < 0.05). There were 108 patients (55.7%) with large HCC (diameter > 5 cm) in the HIRI group, while the number of patients with large HCC in the control group was 83 (68.6%), with statistical difference between the 2 groups (X2=4. 12, P <0.05). The serum levels of aspartate aminotransferase on postoperative day 3 and day 7 were 255 U/L and 112 U/L, which were significantly higher than 128 U/L and 35 U/L in the control group (X2 =4.57, 5.89, P <0.05). The level of total bilirubin on postoperative day 3 was 56 U/L in the HIRI group, which was significantly higher than 39 U/L in the control group (X2=4.79, P <0.05). The disease-free survival rate and cumulative survival rate in the HIRI group were significantly lower than those in the control group (X2 = 5.93, 8. 32, P < 0. 05). Perioperative blood loss, diameter of tumor, portal triad clamping and portal vein invasion were independent factors influencing the diseasefree survival rate. Conclusions HIRI induced by Pringle maneuver significantly decreases the disease-free survival rate and cumulative survival rate of HCC patients after hepatectomy.%目的 探讨PrinCe法肝门阻断所致的肝脏缺血再灌注损伤是否影响肝癌肝切除患者的预后.方法 回顾性分析2004年1月至2008年12月西南医院收治的315例行肝癌肝切除患者的临床资料.将术中进行肝切除时采用Pringle法肝门阻断的分为缺血再灌注组(194例);肝切除时采用CUSA刀、Tissuelink电刀而没有进行肝门阻断的分为非缺血组(121例).采用:检验、X2检验、Kaplan-Meier生存曲线、Log-rank检验和Cox回归模型分析两组患者的术前、术中和预后情况.结果 缺血再灌注组中位年龄为49岁,较非缺血组中位年龄59岁明显年轻(X2=4.12,P<0.05).缺血再灌注组肿瘤直径5 cm者占55.7%(108/194),非缺血组5 cm者占68.6%(83/121),两组比较差异有统计学意义(X2=4.12,P<0.05).缺血再灌注组术后第3、7天AST分别为255 U/L和112 U/L,明显高于非缺血组的128 U/L和35 U/L(X2=4.57,5.89,P<0.05);缺血再灌注组术后第3天Tbil为56 U/L,高于非缺血组的39 U/L(X2=4.79,P<0.05);缺血再灌注组的无瘤生存率和累积生存率均显著低于非缺血组(X2=5.93,8.32,P<0.05).术中出血量、肿瘤直径、是否行肝门阻断和有无门静脉侵犯是无瘤生存率的独立影响因素.结论 采用Pringle法肝门阻断导致的肝脏缺血再灌注损伤可明显降低肝癌肝切除患者术后的无瘤生存率和累积生存率.

著录项

  • 来源
    《中华消化外科杂志》 |2009年第2期|103-106|共4页
  • 作者

    夏锋; 王曙光; 别平; 马宽生; 李晓武; 郑树国; 冯晓彬; 董家鸿;

  • 作者单位

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

    400038,重庆,第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 肿瘤学;
  • 关键词

    肝肿瘤; 缺血再灌注损伤; Pringle法肝门阻断; 肝切除术;

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