半肝缺血预处理在肝硬化肝癌手术中的临床应用价值

目的 探讨半肝缺血预处理（HIP）对肝硬化肝癌患者肝切除的保护作用及临床价值.方法 将60例行开腹手术的肝癌患者按入肝血流阻断方式的不同分为两组,即HIP组（20例）和半肝血流阻断法（HHV）组（40例）,比较两组的临床效果.结果 HIP组术中出血量（自然对数）、术后输血病例数、术后输血量分别为5.7±0.7、3例和（333.3±115.5）ml,均明显少于HHV组的6.1±0.6、18例及（1 433.3±918.4）ml,差异均有统计学意义（t=2.25,P=0.028;x2=5.27,P=0.022;t=4.86,P＜0.001）.两组手术时间、术后住院时间、并发症及肠道通气时间差异均无统计学意义（均P＞0.05）.术后第1、3、5、7天凝血酶原时间活动度HIP组均高于HHV组（均P＜0.05）.HIP组术后一周内有7例丙氨酸氨基转移酶恢复正常,HHV组仅1例（P=0.001）.结论 半肝缺血预处理法可能提高肝硬化肝癌患者手术的安全性,并有助于术后肝功能及早恢复.

Clinical value of hemi-hepatic ischemic preconditioning in resection for hepatocellular carcinoma patients with cirrhosis

Objective To investigate the protective effect and clinical value of hemi-hepatic ischemic preconditioning with continuous clamping （HIP） in hepatocellular carcinoma patients with cirrhosis.Methods A concurrent controlled trial was performed from February 2011 to May 2014,60 cases of hepatocellular carcinoma patients with cirrhosis were divided into HIP group （n =20） and HHV group（hemi-hepatic vascular inflow occlusion,n =40） according to the hepatic inflow occlusion methods during resection.Clinical efficacy was compared between two groups.Results Intraoperaive blood loss（Log）,cases transfused postoperation and postoperative transfusion requirement in HIP group were 5.7±0.7,3 cases and （333.3±115.5） ml,the HHV group were 6.1±0.6,18 cases and （1433.3±918.4） ml,the HIP group were all significantly less than HHV group （t =2.25,P =0.028; x2 =5.27,P =0.022; t =4.86,P ＜ 0.001）.No significant difference was found in operating time,postoperative hospital stay,complications and intestinal ventilation time （all P ＞ 0.05）.HIP group had a significantly higher level of prothrombin time activity at day 1,3,5 and 7 postoperation （P ＜ 0.05）.Cases of ALT recovering within one week had significant difference between the two groups （HIP group 7 cases,HHV group 1 case,P =0.001）.Although no significant difference was found in regarding aminotransferase,total bilirubin and albumin （all P ＞ 0.05） during any postoperative stage.Conclusion HIP maybe can improve operation safety for hepatocellular carcinoma patients with cirrhosis and promote early recovery of liver function.