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[半肝血管阻断技术与非半肝血管阻断技术肝切除术后血清转氨酶、乳酸脱氢酶、总胆红素及碱性磷酸酶水平变化的临床研究]

[Clinical studies on changes in serum transaminase, lactate dehydrogenase, total bilirubin and alkaline phosphatase levels after hepatectomy with and without the hemihepatic vascular occlusion technique].

作者信息

Mori T, Makuuchi M, Kobayashi J, Sukigara M, Yamasaki S, Hasegawa H

出版信息

Nihon Geka Gakkai Zasshi. 1985 Jul;86(7):837-45.

PMID:4047022
Abstract

Changes of serum glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), lactate dehydrogenase (LDH), total-bilirubin (T-Bil) and alkaline-phosphatase (AL-P) before operation and for one week of the postoperative period were studied in 45 patients (32 cirrhotic, 13 non-cirrhotic patients) who underwent hepatectomy with the hemihepatic vascular occlusion technique, and compared with 108 patients (42 cirrhotic, 66 non-cirrhotic patients) without it. The blood loss during hepatectomy with hemihepatic vascular occlusion markedly decreased 1500 ml on the average, compared with non-occluded patients. Serum GPT, GOT and LDH level elevated in several postoperative days, however, there was no difference between both groups. Serum total bilirubin level of patients without hemihepatic vascular occlusion elevated more than those with it. This difference was statistically significant. This tendency was more evident in the patients with cirrhosis. Serum AL-P level of patients without hemihepatic vascular occlusion decreased statistically less than those with it. This tendency was more prominent in patients with cirrhosis. With these results, there was no evidence of augmenting the postoperative liver damage by hemihepatic vascular occlusion, even in the patient with cirrhosis. Moreover, the elevation of postoperative serum total bilirubin level was suppressed by hemihepatic vascular occlusion because of the minimum blood loss and minimum blood transfusion.

摘要

对45例(32例肝硬化患者,13例非肝硬化患者)采用半肝血管阻断技术进行肝切除术的患者,研究其术前及术后一周血清谷草转氨酶(GOT)、谷丙转氨酶(GPT)、乳酸脱氢酶(LDH)、总胆红素(T - Bil)和碱性磷酸酶(AL - P)的变化,并与108例(42例肝硬化患者,66例非肝硬化患者)未采用该技术的患者进行比较。与未阻断血管的患者相比,采用半肝血管阻断技术进行肝切除术时的平均失血量明显减少,降至1500毫升。术后几天血清GPT、GOT和LDH水平有所升高,但两组之间无差异。未采用半肝血管阻断技术的患者血清总胆红素水平升高幅度大于采用该技术的患者。这种差异具有统计学意义。在肝硬化患者中这种趋势更为明显。未采用半肝血管阻断技术的患者血清AL - P水平下降的统计学幅度小于采用该技术的患者。这种趋势在肝硬化患者中更为突出。基于这些结果,即使是肝硬化患者,也没有证据表明半肝血管阻断会增加术后肝损伤。此外,由于失血量和输血量最少,半肝血管阻断抑制了术后血清总胆红素水平的升高。

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