Terlipressin促进肝癌合并肝硬化半肝切除术后肝再生的前瞻性非随机研究

Effect of Terlipressin on liver regeneration after hemihepatectomy for liver cancer with cirrhosis:a prospective nonrandomized trial

目的探讨Terlipressin(特利加压素)促进肝硬化肝癌半肝切除术后肝再生的临床疗效。方法前瞻性非随机分析2017年10月至2018年8月福建医科大学孟超肝胆医院符合标准的68例肝硬化肝癌患者并行半肝切除的临床资料,按肝切除术后有无使用Terlipressin分为试验组(37例)和对照组(31例)。采用IQQA-Liver系统对所有患者术前、术后5 d及2个月的CT图像进行三维可视化重建,计算术后5 d肝再生率(liver regeneration rate,LRR5 d)、术后2个月肝再生率(LRR2 mon)、肝继续再生率(?LLR=LRR2 monLLR5 d)。比较两组患者肝切除术后肝再生率、肝功能变化、并发症等。结果试验组和对照组基线资料具有可比性,肿瘤最大直径、肿瘤数目、术前AFP水平、术前HBV-DNA滴度等无统计学差异(P>0.05)。两组之间LRR5 d未见统计学差异[(16.97±7.62)%vs(16.06±10.22)%,P>0.05],但试验组LRR2 mon、?LLR明显高于对照组[(28.69±16.94)%vs(20.55±10.37)%,P=0.023;(12.63±13.29)%vs(3.58±9.13)%,P=0.002]。试验组患者术后肝功能恢复时间更短,术后腹腔感染发生率更低(P<0.05),但是两组之间严重并发症发生率无统计学差异(P>0.05)。结论Terlipressin不仅能促进肝癌合并肝硬化患者术后的康复,也能促进半肝切除术后肝再生,但该结论需要更加强有力的证据。

Objective To investigate the promotion of Terlipressin in liver regeneration after hemihepatectomy for liver cancer with cirrhosis.Methods A total of 68 primary liver cancer patients with cirrhosis who admitted in the Mengchao Hepatobiliary Hospital of Fujian Medical University from Oct.2017 to Aug.2018 were enrolled in this prospective nonrandomized study,and patients were divided into treatment group(37 cases treated with Terlipressin)and control group(31 cases).3 D visual reconstructions of liver preoperative,5 days and 2 months postoperative were conducted with IQQA-Liver system,and liver regeneration rate(LLR)at 5 th day after hepatectomy(LLR5 d),at 2 months post hepatectomy(LLR2 mon),and continued LLR(?LLR=LRR2 mon-LLR5 d)were calculated,respectively.LLR,recovery of liver function,and complication were investigated.Results The baseline characteristics between the two groups were comparable.In the treatment group,LLR2 mon and?LLR were higher[(28.69±16.94)%vs(20.55±10.37)%,P=0.023;(12.63±13.29)%vs(3.58±9.13)%,P=0.002],though there was no significant difference in LRR5 d between the two groups[(16.97±7.62)%vs(16.06±10.22)%,P>0.05].The recovery time of liver function and postoperative rehabilitation were shorter in the experiment group than those in the control group,and the incidence of abdominal infection was higher than that in the control group(P<0.05),but there was no significant difference in the incidence of serious complications between the twogroups(P>0.05).Conclusion Terlipressin was effective both in the postoperative recovery and in the promotion of liver regeneration after hemihepatectomy for patients with liver cancer and cirrhosis.But Terlipressin needs much more powerful evidence.