本文選題：缺血再灌注損傷 + Pringle��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究背景和目的:原發(fā)性肝癌是世界上最常見(jiàn)的惡性腫瘤之一,其腫瘤相關(guān)死亡率在我國(guó)位居第二位。手術(shù)切除是目前治療原發(fā)性肝癌的首選方法,盡管近年來(lái)手術(shù)技術(shù)的進(jìn)步提高了肝癌切除率,但術(shù)后亦復(fù)發(fā)轉(zhuǎn)移導(dǎo)致肝癌預(yù)后不良。國(guó)內(nèi)外臨床研究表明,肝癌根治性切除術(shù)后3年復(fù)發(fā)率為40%-50%,5年轉(zhuǎn)移復(fù)發(fā)率為60-70%,5年總體生存率僅為20-50%。因此,如何預(yù)防或避免肝癌術(shù)后復(fù)發(fā)是肝臟外科面臨的巨大挑戰(zhàn)。肝癌切除術(shù)中,肝門阻斷術(shù)(Pringle Maneuver)是臨床常用的阻斷入肝血流的有效方法。雖然可以有效降低術(shù)中出血量,但是不可避免的引起肝臟缺血再灌注損傷(IRI),進(jìn)而損害殘肝增殖修復(fù)能力。實(shí)驗(yàn)研究表明,IRI對(duì)血液中殘留的腫瘤細(xì)胞的遷移、黏附、定植、生長(zhǎng)等過(guò)程均有重要影響,與肝癌術(shù)后的復(fù)發(fā)、轉(zhuǎn)移關(guān)系密切。隨著Pringle Maneuver時(shí)間的延長(zhǎng),IRI加重,但是目前尚未有明確的Pringle Maneuver時(shí)間對(duì)腫瘤復(fù)發(fā)率影響的報(bào)道。因此,我們對(duì)本中心近5年實(shí)施的肝癌根治性切除術(shù)的病例進(jìn)行了回顧性研究,以探討Pringle Maneuver所致的肝IRI時(shí)間與腫瘤復(fù)發(fā)的關(guān)系。材料與方法:回顧性分析120例原發(fā)性肝癌患者臨床資料,來(lái)源于吉林大學(xué)中日聯(lián)誼醫(yī)院醫(yī)院2010年1月至2014年12月期間進(jìn)行根治性切除術(shù)的原發(fā)性肝癌患者。統(tǒng)計(jì)患者Pringle Maneuver阻斷時(shí)間,無(wú)瘤生存時(shí)間,總體生存時(shí)間,和其他可能影響結(jié)果的預(yù)后因素。根據(jù)研究?jī)?nèi)容,制定并輸寫合格的病例調(diào)查表,通過(guò)統(tǒng)一隨訪程序獲得結(jié)局資料。最后對(duì)數(shù)據(jù)用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:120例進(jìn)行根治性切除的原發(fā)性肝癌患者中,男性96例,女性24例,男女比例為4:1。年齡范圍為20-73歲,平均年齡54歲。非Pringle Maneuver術(shù)式的38例(占總?cè)藬?shù)32%),進(jìn)行Pringle Maneuver術(shù)式的82例(占總?cè)藬?shù)68%),其中Pringle Maneuver時(shí)間"f15min有43例(占Pringle Maneuver組52%),Pringle Maneuver時(shí)間15min有39例(占Pringle Maneuver組48%)。術(shù)后5年內(nèi)腫瘤復(fù)發(fā)的患者共75例,占總?cè)藬?shù)比例為63%。根據(jù)Pringle maneuver時(shí)間的不同分為三組Pringle maneuver為0,"f15,15分鐘,三組平均無(wú)瘤生存時(shí)間分別是30,29,20個(gè)月。Pringle maneuver為0,"f15,15分鐘三組的平均總生存時(shí)間分別是43,42,30個(gè)月。統(tǒng)計(jì)數(shù)據(jù)發(fā)現(xiàn)Pringle Maneuver阻斷時(shí)間超過(guò)15分鐘時(shí)會(huì)增加肝癌復(fù)發(fā)的風(fēng)險(xiǎn)(P0.001),而Pringle Maneuver小于15分鐘對(duì)肝癌復(fù)發(fā)無(wú)明顯影響。Pringle Maneuver阻斷時(shí)間超過(guò)15分鐘的患者,其總體生存時(shí)間和無(wú)瘤生存時(shí)間均小于對(duì)照組(P0.001)。結(jié)論:術(shù)中長(zhǎng)時(shí)間進(jìn)行Pringle Maneuver會(huì)增加肝癌患者術(shù)后腫瘤復(fù)發(fā)的風(fēng)險(xiǎn),縮短患者總生存時(shí)間和無(wú)瘤生存時(shí)間。其他影響術(shù)后肝癌復(fù)發(fā)的獨(dú)立危險(xiǎn)因素有:AFP水平20ng/ml,腫瘤大小,多發(fā)腫瘤,腫瘤多葉,腫瘤無(wú)包膜,和腫瘤分級(jí)III IV,微血管浸潤(rùn)。
[Abstract]:Background and objective: primary liver cancer is one of the most common malignant tumors in the world. Surgical resection is the first choice in the treatment of primary liver cancer at present. Although the progress of surgical technique has improved the resection rate of liver cancer in recent years, recurrence and metastasis also lead to poor prognosis of liver cancer. The clinical studies at home and abroad showed that the recurrence rate was 40-50 in 3 years after radical resection of liver cancer, 60-70 in 5 years of metastasis, and 20-50 in overall survival rate of 5 years. Therefore, how to prevent or avoid postoperative recurrence of liver cancer is a huge challenge for liver surgery. Pringle Maneuvere is an effective method to block hepatic blood flow in hepatectomy. Although it can effectively reduce the amount of intraoperative bleeding, it inevitably leads to liver ischemia reperfusion injury, thus impairing the ability of residual liver proliferation and repair. The experimental study showed that IRI had an important effect on the migration, adhesion, colonization and growth of residual tumor cells in the blood, and was closely related to the recurrence and metastasis of liver cancer after operation. With the prolongation of Pringle Maneuver time, however, there is no clear report on the effect of Pringle Maneuver time on tumor recurrence rate. In order to investigate the relationship between the time of liver IRI induced by Pringle Maneuver and the recurrence of liver cancer, we retrospectively studied the cases of radical resection of hepatocellular carcinoma (HCC) performed in our center in recent 5 years. Materials and methods: the clinical data of 120 patients with primary liver cancer (PHC) were retrospectively analyzed. The clinical data were collected from the patients undergoing radical resection of HCC from January 2010 to December 2014 in the Sino-Japanese Friendship Hospital of Jilin University. Pringle Maneuver blocking time, tumor-free survival time, total survival time, and other prognostic factors that may affect the outcome were counted. According to the content of the study, a qualified case questionnaire was developed and written, and the outcome data were obtained through a unified follow-up procedure. Finally, the data are analyzed by SPSS21.0 software. Results among 120 patients with primary liver cancer undergoing radical resection, 96 were male and 24 were female, with a ratio of 4: 1. The age range was 20 to 73 years, with an average age of 54 years. There were 38 cases of non Pringle Maneuver operation (32 cases) and 82 cases of Pringle Maneuver operation (68 cases). Among them, 43 cases were Pringle Maneuver time "f15min" (39 cases in Pringle Maneuver group) and 39 cases in Pringle Maneuver group (48 cases in Pringle Maneuver group). There were 75 cases of tumor recurrence within 5 years after operation, accounting for 63% of the total number of patients. According to the difference of Pringle maneuver time, there were three groups with Pringle maneuver of 0, "f15t 15 minutes, the mean tumor-free survival time of the three groups was 30 ~ 29m, 20 months. Pringle maneuver was 0," the average total survival time of f1515 minutes group was 43 ~ 42and 30 months, respectively. Statistical data showed that Pringle Maneuver blocking time more than 15 minutes increased the risk of liver cancer recurrence (P 0.001), while Pringle Maneuver less than 15 minutes had no significant effect on HCC recurrence. Pringle Maneuver blocking time was more than 15 minutes in patients with HCC recurrence. The overall survival time and tumor-free survival time of the control group were smaller than that of the control group (P 0.001). Conclusion: prolonged intraoperative Pringle Maneuver may increase the risk of tumor recurrence and shorten the total survival time and tumor-free survival time. Other independent risk factors for recurrence of liver cancer after operation were 20 ng / ml of III, tumor size, multiple tumors, multilobular tumor, no capsule, and tumor grade III IV, microvessel infiltration.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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