老年人原发性肝癌肝切除围手术期肝功能维护和支持

The support of hepatic function after primary hepatic carcinoma operation in senile people

目的研究老年人原发性肝癌肝切除围手术期肝功能不全的原因及防治措施,以提高其临床疗效。方法回顾分析原发性肝癌肝切除病例62例,老年组(60以上)32例,非老年组(60以下)30例,分析围手术期老年组与非老年组、肝门阻断组和非阻断组、出血量多组(>500ml)和出血量少组(<500ml)的肝功能变化。结果老年组和非老年组手术后肝功能变化无显著差异(P>0.05);阻断组与非阻断组术后第1天ALT分别为609.5±526.9 U/L和289.4±262.1 U/L(P<0.05),有显著差异;出血量多组与出血量少组比较,ALT分别为术后第1天733.2±492.4 U/L和197.4±113.0 U/L(P<0.05)、第3天683.4±415.0U/L和152.8±100.6 U/L(P<0.05)、第7天299.2±260.7 U/L和82.8±64.0 U/L(P<0.05)、第10天73.9±22.2 U/L和44.7±13.4 U/L(P<0.05),均有显著差异。结论老年人围手术期肝功能不全主要原因为术中大出血,其次是肝门阻断,年龄不是关键因素。加强术前肝功能及其代偿的评估,提高手术技能减少术中出血等对肝脏的侵袭,提升术后护肝处理是防治老年人围手术期肝功能不全的主要措施。

Objective To investigate the cause of hepatic failure after hepatectomy in the patients with primary hepatic carcinoma in senile people and explore its diagnosis and treatment. Methods Hepatic function of 62 patients with primary hepatic carcinoma admitted between January 2003 and September 2005 was analyzed retrospectively. The patients were divided into two groups： a senile people group （ 〉 60 years old ） and a younger people group （ 〈 60 years old ）. Results The levels of alanine aminotransferase （ ALT ） during perioperative period were ： 609.5 ± 526.9 U/L and 289.4 ± 262. 1 U/L（ P 〈 0.05 ） in 1 days after operation in hepatopetal blood occlusion or not, 733.2 ±492.4 U/L and 197.4 ± 113.0 U/L（P 〈0.05 ） in 1 days, 683.4 ±415.0 U/L and 152.8 ± 100.6 U/L （ P 〈 0.05 ） in 3 days ,299.2 ± 260.7 U/L and 82.8 ± 64.0 U/L（ P 〈 0.05 ） in 7 days, 73.9 ＋ 22.2 U/L and 44.7 ± 13.4 U/L （P 〈 0.05） in 10 days after operation in more or less of intraoperative bleeding. The ALT was increased after operation. The amplitude of increasing were significantly different between two groups. Conclusion The liver function failure is significantly correlated with the amount of intraoperative bleeding and the measures to prevent the liver function failure are enough reserve of the liver function.