本文選題：肝儲備功能　切入點：肝切除　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察并研究膽堿酯酶(Cholinesterase,CHE)在不同肝臟組織中與凝血酶原時間(Prothrombin time,PT)、白蛋白(Albumin,ALB)、膽紅素(Bilirubin,BIL)等評價肝臟儲備功能指標(biāo)間的關(guān)系,并分析肝切除各項手術(shù)因素對于CHE的影響,以此評價CHE對肝切除術(shù)病例肝臟儲備功能的評估作用及意義,為建立肝切除術(shù)術(shù)前肝儲備功能新型評估系統(tǒng)提供臨床依據(jù)。方法:1.回顧性觀察2010年-2013年在寧夏醫(yī)科大學(xué)總醫(yī)院肝膽外科行肝臟切除術(shù)的病例、在寧夏醫(yī)科大學(xué)總醫(yī)院感染疾病科因肝硬化住院治療的病例、以及健康體檢者的CHE、ALB、PT、BIL的差異,分析CHE在Child分級之間的關(guān)系。2.測定2014年4月-2015年3月在我科行肝切除的原發(fā)性肝癌、肝血管瘤患者圍手術(shù)期的CHE、血清白蛋白、凝血酶原時間、膽紅素水平及術(shù)中失血量、肝門阻斷時間、手術(shù)時間及標(biāo)準(zhǔn)殘肝率(標(biāo)準(zhǔn)殘肝率=術(shù)后肝體積/術(shù)前肝體積),分析CHE與上述指標(biāo)之間的相關(guān)性。通過單因素分析和Pearson相關(guān)分析確定CHE對肝切除術(shù)肝功能儲備功能的評估作用。結(jié)果:在Child分級中,膽堿酯酶水平在各組間差異具有統(tǒng)計學(xué)意義(P0.05);膽堿酯酶與血清白蛋白、凝血酶原時間的相關(guān)性各組間均具有統(tǒng)計學(xué)意義(P0.05),膽堿酯酶與膽紅素相關(guān)性在Child C級中具有統(tǒng)計學(xué)意義(P0.05)。膽堿酯酶水平在肝切除術(shù)前、后變化差異具有統(tǒng)計學(xué)意義,與Child分級研究術(shù)后差異具有統(tǒng)計學(xué)意義(P0.05);膽堿酯酶變化率與手術(shù)時間、術(shù)中出血量、肝門阻斷時間的相關(guān)性研究均無統(tǒng)計學(xué)意義(P0.05),膽堿酯酶變化率與殘肝率呈正相關(guān)(r=0.487,P=0.029)。結(jié)論:血清膽堿酯酶水平變化與肝臟功能受損狀況具有一致性。膽堿酯酶變化率與殘肝率有著緊密的聯(lián)系,肝儲備功能受肝切除外影響因素較小,膽堿酯酶在一定程度上可反應(yīng)肝儲備功能的變化。
[Abstract]:Objective to investigate the relationship between cholinesterase Cholinesterase (che) and prothrombin time prothrombin time (prothrombin time), albumin albumin Albumin (ALBN), bilirubin bilirubin (bilirubin bilirubin bilirubin CHE) in different liver tissues, and to analyze the effect of various surgical factors on CHE. To evaluate the role and significance of CHE in evaluating hepatic reserve function in patients undergoing hepatectomy. To provide the clinical basis for establishing a new evaluation system of liver reserve function before hepatectomy methods: 1. Retrospective observation was made on the cases of hepatectomy performed in the Department of Hepatobiliary surgery, General Hospital of Ningxia Medical University from 2010 to 2013. The relationship between CHE and Child grade was analyzed in patients with liver cirrhosis hospitalized in Department of General Hospital infection, Ningxia Medical University, and in healthy persons. The relationship between CHE and Child grade was analyzed. The hepatectomy of primary liver cancer was performed in our department from April 2014 to March 2015. Perioperative CHE, serum albumin, prothrombin time, bilirubin level, intraoperative blood loss, hepatic portal occlusion time in patients with hepatic hemangioma. The operative time and the standard liver remnant rate (standard liver remnant rate = postoperative liver volume / preoperative liver volume) were analyzed. The correlation between CHE and the above indexes was analyzed. The liver function reserve of CHE for hepatectomy was determined by univariate analysis and Pearson correlation analysis. Function evaluation. Results: in the Child classification, The levels of cholinesterase were significantly different among the groups (P 0.05), and the levels of cholinesterase and serum albumin, The correlation between prothrombin time and cholinesterase and bilirubin was statistically significant in all groups. The level of cholinesterase was significantly different before and after hepatectomy in Child C grade. There was a significant difference between the study of cholinesterase and Child, the change rate of cholinesterase, the time of operation and the amount of blood lost during operation. There was no significant correlation between hepatic portal occlusion time and cholinesterase activity. There was a positive correlation between cholinesterase level and residual liver rate. Conclusion: the change of serum cholinesterase level is consistent with liver function damage. There is a close relationship between the rate of liver remnant and the rate of residual liver. The liver reserve function was less affected by hepatectomy, and cholinesterase could reflect the change of liver reserve function to some extent.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.3

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