肝缺血预处理在肝切除术中应用价值的随机对照研究

The value of hepatic ischemic preconditioning in hepatectomy with a prospective randomized controlled study

目的探讨缺血预处理在肝切除术中的临床应用价值。方法采用前瞻性随机双盲对照的研究方法将安徽医科大学第一附属医院肝胆外科2004年12月至2006年6月收治的48例肝切除患者随机分成两组：预处理组和对照组，每组24例。预处理组采用阻断入肝血流5min，开放5min的预处理方式，两组切肝时均按常规肝门阻断法（Pringle法）。比较两组术后第1、3、7天肝功能变化情况，以及术后并发症发生率、围手术期病死率及总住院天数。结果预处理组中肝门阻断时间5～80min，平均31min；住院天数13～50d，平均20d。对照组中肝门阻断时间10～60min，平均27min；住院天数10～33d，平均17d。除预处理组中有1例术后3个月死于慢性肝功能衰竭外，余47例均恢复良好。两组术后第1、3、7天丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、白蛋白的变化均无统计学意义（P〉0．05）。结论应用阻断入肝血流5min的预处理方法无助于肝切除术后患者肝功能的恢复。

Objective To evaluate the value of ischemic preconditioning in clinical hepatectomy. Methods A total of 48 unselected patients undergoing liver resection were analyzed by randomized controlled trial from December 2004 to June 2006. Forty-eight unselected patients were randomized into two groups ： IP group （ 5 minutes of ischemia followed by 5 minutes of reperfusion ） and control group （received Pringle＇s maneuverno and no IP was given）. Postoperative days 1,3 and 7 ,the liver function were checked. Perioperative mortality, morbidity and hospitalized days were compared. Results In IP group, ischemic times were 5-80 min, mean 31 min, hospitalized days were 13-50 days, mean 20 days. In control group,ischemic times were 10-60 min, mean 27 min, hospitalized days were 10-33 days, mean 17 days. Forty-seven patients were satisfactory with postoperative recovery, except one patient died of chronic liver dysfunction after 3 months postoperatively. Postoperative days 1,3 and 7, the ALT, AST, TBIL, ALB levels in two groups were not statistically significant （ P 〉 0. 05 ）. Conclusions The clinical use of IP through 5 minutes of warm ischemia in this technique of hepatectomy does not protect the liver from hepatic injury induced by the IRI.