人类网状内皮系统对肝大部切除的适应性反应。
The adaptive response of the reticuloendothelial system to major liver resection in humans.
作者信息
Schindl Martin J, Millar Alistair M, Redhead Doris N, Fearon Kenneth C H, Ross James A, Dejong Cornelius H C, Garden O James, Wigmore Stephen J
机构信息
Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER) and the Department of Surgery, Royal Infirmary Edinburgh, University of Edinburgh, Edinburgh, United Kingdom.
出版信息
Ann Surg. 2006 Apr;243(4):507-14. doi: 10.1097/01.sla.0000205826.62911.a7.
OBJECTIVE
To evaluate the contribution of the liver to total circulatory reticuloendothelial system (RES) phagocytosis capacity in patients undergoing liver resection and to compare it with values in end-stage chronic liver disease.
SUMMARY BACKGROUND DATA
The mechanism whereby major liver resection is associated with a high incidence of infection is unknown. Significant impairment of RES phagocytosis has been described in liver failure, rendering such patients susceptible to infection; and we hypothesized that similar impairment might occur following major liver resection.
METHODS
A prospective study was conducted in which Tc-albumin microspheres blood clearance served as a parameter for RES phagocytosis and was studied together with indocyanine green blood clearance, actual liver volume measured by three-dimensional image analysis, and a clinical score of hepatic dysfunction in 17 patients undergoing liver resection and in 8 patients with end-stage chronic liver disease assessed for liver transplantation.
RESULTS
When expressed relative to volume unit of residual liver, microspheres clearance increased significantly in the immediate postoperative period (day 1) following major (0.009% versus 0.022% min(-1) mL(-1), P < 0.001), but not minor liver resection. In contrast, the absolute rate of microsphere clearance decreased following major resection (15% min(-1) versus 10% min(-1), P < 0.001) and was comparable with the rate observed in end-stage chronic liver disease (9% min(-1)). This decrease in circulatory microspheres clearance after resection paralleled a decrease in indocyanine green clearance (R2 = 0.511, P = 0.006), and there was a trend for those with moderate liver dysfunction to have lower microspheres clearance rates (P = 0.068).
CONCLUSION
Preservation of a minimum volume of functioning liver is a prerequisite for adequate RES phagocytosis capacity, and failure of this system may predispose patients undergoing major liver resection to infection as observed in clinical studies.
目的
评估肝切除患者肝脏对全身循环性网状内皮系统（RES）吞噬能力的贡献，并将其与终末期慢性肝病患者的值进行比较。
总结背景数据
肝大部切除术后感染发生率高的机制尚不清楚。已有研究描述肝衰竭时RES吞噬功能显著受损，使此类患者易发生感染；我们推测肝大部切除术后可能发生类似的损害。
方法
进行一项前瞻性研究，以锝标记白蛋白微球血液清除率作为RES吞噬功能的参数，并与吲哚菁绿血液清除率、通过三维图像分析测量的实际肝脏体积以及17例接受肝切除的患者和8例接受肝移植评估的终末期慢性肝病患者的肝功能临床评分一起进行研究。
结果
相对于残余肝的体积单位，肝大部切除术后即刻（第1天）微球清除率显著增加（0.009%对0.022% min⁻¹ mL⁻¹，P < 0.001），而小肝切除术后未增加。相反，肝大部切除术后微球清除的绝对速率降低（15% min⁻¹对10% min⁻¹，P < 0.001），且与终末期慢性肝病中观察到的速率相当（9% min⁻¹）。切除术后循环微球清除率的降低与吲哚菁绿清除率的降低平行（R² = 0.511，P = 0.006），并且肝功能中度受损患者的微球清除率有降低的趋势（P = 0.068）。
结论
保留最小体积的功能肝是获得足够RES吞噬能力的前提条件，正如临床研究中所观察到的，该系统功能衰竭可能使肝大部切除患者易发生感染。
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