泡型肝包虫病患者肝切除术后肝储备功能的参数评价

发布时间：2018-12-19 15:20

【摘要】：目的:探讨标准残肝体积(standard remnantliver volume,SRLV)、胆碱酯酶(cholinesterase,CHE)、γ-谷氨酰转肽酶(gamma-glutamyl transferase,GGT)、碱性磷酸酶(alkal inephosphates,ALP)、肝硬化(liver cirrhosis,LC)对于泡型肝包虫病患者行肝切除术后肝储备功能的影响程度,并进一步证实该因素与肝功能代偿不全的关系。方法:对青海省人民医院普外科2013-03/2015-3收治的60例泡型肝包虫病患者行肝切除术,通过测定TLV、SRLV、CHE、GGT、ALP的值及有无LC,采用多因素Logistic回归方程,分析SRLV、CHE、GGT、ALP及LC对泡型肝包虫病患者肝切除术后对于肝脏储备功能的影响及其大小。使用受试者操作曲线分析,得出影响肝储备功能指标对肝功能不全的预测价值及临界值,并计算出该临界值导致肝功能不全的发生率。结果:术前导致泡型肝包虫病患者肝储备功能下降的因素为LC、肝脏的总体积(totalliver volume,TLV)、GGT(P0.05),OR值分别为为2.484、0.2796、1.0000。而术后肝储备功能下降的因素为为LC、SRLV、GGT(P0.05),其中LC影响最大,OR值为6.7848。其次为SRLV、GGT,OR值分别为1.00002、1.00031。SRLV对预测肝功能不全的临界值为498.50ml/m2,GGT对预测肝功能不全的临界值97.5U/L。当SRLV498.50ml/m2时,肝功能不全发生率为50%,当GGT97.5U/L时,肝功能不全发生率为45.5%。CHE和ALP对泡肝患者手术前后的肝储备功能均无明显影响,手术因素导致泡型肝包虫患者术后肝储备功能下降。结论:影响青海地区泡型肝包虫患者肝储备功能的因素依次为LC、SRLV、GGT。患者术后储备功能明显低于术前,导致肝储备功能下降的因素可引起肝功能代偿不全。
[Abstract]:Objective: to investigate standard residual liver volume (standard remnantliver volume,SRLV), cholinesterase (cholinesterase,CHE), 纬 -glutamyl transpeptidase (gamma-glutamyl transferase,GGT), alkaline phosphatase (alkal inephosphates,ALP), (liver cirrhosis, in liver cirrhosis. The effect of LC on hepatic reserve function after hepatectomy in patients with alveolar hepatic hydatidosis and the relationship between this factor and compensatory insufficiency of liver function were further confirmed. Methods: 60 patients with alveolar hepatic hydatid disease admitted in the Department of General surgery of Qinghai Provincial people's Hospital 2013-03 / 2015-3 were treated with hepatectomy. SRLV,CHE, was analyzed by measuring the value of TLV,SRLV,CHE,GGT,ALP and using multivariate Logistic regression equation with or without LC,. Effects of GGT,ALP and LC on hepatic reserve function after hepatectomy in patients with alveolar hydatid disease. The predictive value and critical value of the indexes affecting liver reserve function for liver insufficiency were obtained by using the operation curve analysis of subjects and the incidence of liver insufficiency caused by this critical value was calculated. Results: the decrease of hepatic reserve function in patients with alveolar hydatid disease before operation was caused by the total volume of LC, liver (totalliver volume,TLV), GGT (P0.05), OR = 2.484), OR = 0.2796v 1.0000respectively). However, the decrease of liver reserve function after operation was caused by LC,SRLV,GGT (P0.05), in which LC had the greatest effect, and OR value was 6.7848. Secondly, the critical value of SRLV,GGT,OR for predicting hepatic insufficiency was 498.50ml / m2GGT with a critical value of 97.5U / L for predicting hepatic insufficiency, respectively. The critical value of SRLV,GGT,OR was 1.00002s1.00031.SRLV for predicting hepatic insufficiency. When SRLV498.50ml/m2 was performed, the incidence of hepatic insufficiency was 50%, while in GGT97.5U/L, the incidence of hepatic insufficiency was 45.5%.CHE and ALP, which had no significant effect on hepatic reserve function before and after operation. Postoperative hepatic reserve function decreased in patients with alveolar hydatid disease due to surgical factors. Conclusion: the influencing factors of liver reserve function in patients with alveolar hydatid in Qinghai area are LC,SRLV,GGT.. The postoperative reserve function of the patients was significantly lower than that of the patients before operation, and the factors leading to the decline of the hepatic reserve function could lead to the compensatory insufficiency of the liver function.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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