摘要
目的从术后血清恶性生物学标志物及机体应激性创伤等角度,探讨精准肝切除技术在老年原发性肝癌患者中的应用价值。方法将2014年1月—2016年12月于我院接受手术的118例老年原发性肝癌患者按手术方案划分为两组。观察组(45例)接受精准肝切除,对照组(73例)接受常规肝切除。比较两组术前、术后3 d时血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、谷草转氨酶(AST)、C反应蛋白(CRP)、白细胞介素-6(IL-6)和白细胞计数(WBC)水平,以及术后3 d时检测血清中肝癌活力指标及JAK/STAT信号通路相关分子水平。结果观察组手术时间长于对照组(P<0.05)。术后观察组TBIL、ALT、AST、CRP、IL-6、WBC等指标均显著低于对照组(P<0.05)。术前,术后两组TBIL、ALT、AST、CRP、IL-6均上升,对照组WBC上升(P<0.05)。术后3 d时观察组血清胸苷激酶1(TK1)、Polo样激酶1(Plk1)、B细胞淋巴瘤蛋白2(Bcl-2)、两面神激酶(JAK)、信号转导子和转录激活子(STAT)1、STAT3、STAT5水平均低于对照组(P<0.05)。结论对老年原发性肝癌患者,精准肝切除能减少手术对剩余肝脏组织造成的缺血再灌注损伤及机体应激性创伤,同时能避免肝癌活力因子及恶性生物学信号分子释放入血。
Objective To explore the application value of precise hepatectomy in elderly patients with hepatocellular carcinoma(HCC)from the perspective of serum biological markers and stress trauma.Methods 118 elderly patients diagnosed with HCC in our hospital from January 2014 to December 2016 were divided into two groups according to the operation plan.The observation group(45 cases)received precise hepatectomy,while the control group(73 cases)received the conventional hepatectomy.Serum total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),C reactive protein(CRP)interleukin-6(IL-6)and white blood cell count(WBC)before hepatectomy and at 3 days after hepatectomy in two groups,serum biological markers of HCC at 3 days after hepatectomy in two groups were compared.Results The operation time of the observation group was significantly longer than that of the control group(P<0.05).The indexes of liver function and stress in the observation group were significantly lower than those in the control group(P<0.05).Before and after hepatectomy,the TBIL,ALT,AST,CRP and IL-6 increased significantly in two groups,WBC in the control group increased significantly(P<0.05).After hepatectomy,serum thymidine kinase 1(TK1),Polo like kinase 1(Plk1),B cell lymphoma protein 2(Bcl-2),Janus kinase(JAK)and signal transducer and activator of transcription(STAT)1,STAT3 and STAT5 in the observation group were significantly lower than those in the control group(P<0.05).Conclusion For elderly patients with HCC,precise hepatectomy may lead to prolonged operation time,and can reduce ischemia reperfusion injury and traumatic stress for residual liver tissue,also the method can avoid biological markers from releasing into the blood.
作者
刘文师
刘婷婷
孙光为
富大智
LIU Wenshi;LIU Tingting;SUN Guangwei;FU Dazhi(Department of Hepatobiliary Surgery,The First Hospital of China Medical University,Shenyang Liaoning 110000;Department of Anus and Intestine Surgery,The First Hospital of China Medical University,Shenyang Liaoning 110000)
出处
《中国继续医学教育》
2018年第11期75-78,共4页
China Continuing Medical Education
基金
辽宁省自然科学基金资助项目(2015020529)
关键词
老年患者
原发性肝癌
精准医学
肝切除术
elderly patients
primary liver cancer
precision medicine
hepatectomy
