肝动脉栓塞术后肝脏能量代谢变化的探讨

Influence of hepatic artery embolization on hepatic energy metabolism in hepatoma patients

目的：探讨各种栓塞疗法对肝脏能荷水平的影响及其与术后并发症的关系。材料与方法：对６９例行肝动脉栓塞的肝肿瘤患者连续监测动脉血酮体比率（ＡＫＢＲ），并与常规肝功能指标及术后临床过程进行比较。结果：术后ＡＫＢＲ多呈一过性改变，高剂量的放疗性栓塞及术前黄疸患者术后ＡＫＢＲ降低明显，并恢复较慢，出现多种并发症。患者按术后ＡＫＢＲ值变化分三组：Ａ组３５例，术后ＡＫＢＲ一直保持在０．７以上；Ｂ组３１例，术后ＡＫＢＲ一度降至０．４～０．７，但３～７天内回升至０．７以上；Ｃ组３例，术后ＡＫＢＲ降至０．４以下且不回升，各组并发症发生率依次为５．７％、３２．３％、１００．０％，而各组常规肝功能指标相比较无统计学差异。结论：ＡＫＢＲ是直接反映肝损伤肝活力程度的一个量化指标，对判断肝脏对栓塞疗法的耐受程度及术后并发症的发生具有重要临床价值。

Purpose: To evaluate energy change level of the liver after hepatic artery embolization. Materials and methods: Sixty nine patients with hepatoma were continuously studied for their arterial blood ketone body ratio (AKBR) and compared with their postoperative clinical course or routine liver function test after hepatic artery embolization. Results: AKBR in high radiation dose or jaundice group drastically decreased and recovered slowly. Patients were classified into three groups according to the value of AKBR: group A( 35 cases),the AKBR remained higher than 0.7; group B (31 cases), the AKBR dropped transiently to 0.4～0 7 and then increased up to 0.7; group C (3 cases), the AKBR decreased steadily down below 0.4. The various complications occurring in three groups were 5.7%, 32.3% and 100% respectively. Conclusion: AKBR which reflects hepatic mitochondrial redox state is more reliable as direct indicator to assess hepatic tolerance for embolization therapy than routine liver function test.