• 中山大學附屬第一醫(yī)院肝膽外科（廣州510080）;

目的  探討蛋白酶抑制劑（烏司他丁，UTI）對合并肝硬變的肝癌患者入肝血流阻斷肝切除術(shù)后肝功能的保護作用。
方法  將近期我科收治的原發(fā)性肝癌患者按抽信封法隨機分為UTI組（n=16）： 術(shù)中靜脈滴注UTI 10萬單位，2次/天，術(shù)后連續(xù)用5 d； 對照組（n=15）應用常規(guī)護肝藥物。比較兩組的肝功能變化、血清C-反應蛋白（CRP）和皮質(zhì)醇的濃度。
結(jié)果  術(shù)后第1、3及7天，UTI組的AST及ALT均不同程度地低于對照組，術(shù)后第3天，UTI組的AST、ALT和TBIL均明顯低于對照組（P＜0.05）； 術(shù)后第1天，UTI組的CRP水平顯著低于對照組（P＜0.01）； 對照組血清皮質(zhì)醇水平顯著高于術(shù)前（P=0.046）； 而UTI組術(shù)后血清皮質(zhì)醇水平略高于術(shù)前，但無統(tǒng)計學意義。
結(jié)論  蛋白酶抑制劑烏司他丁能減輕肝硬變肝癌患者入肝血流阻斷切肝術(shù)引起的肝缺血再灌注損傷，并能減輕手術(shù)本身對機體的打擊。

引用本文： 李紹強,梁力建. 蛋白酶抑制劑對肝癌患者入肝血流阻斷肝切除術(shù)后肝功能的保護作用. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(1): 61-64. doi: 復制

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2. Tang ZY, Yu YQ, Zhou XD, et al. Surgery of small hepatocellular carcinoma. Analysis of 144 cases [Ｊ]. Cancer, 1989; 64(2)∶536.
3. Okuhama Y, Shiraishi M, Higa T, et al. Protective effects of ulinastatin against ischemiareperfusion injury [Ｊ]. J Surg Res, 1999; 82(1)∶34.
4. Aihara T, Shiraishi M, Hiroyasu S, et al. Ulinastatin, a protease inhibitor, attenuates hepatic ischemia/reperfusion injury by downregulating TNFalpha in the liver [Ｊ]. Transplant Proc, 1998; 30(7)∶3732.
5. Hamazaki K, Matsubara N, Yunoki Y, et al. Effects of ulinastatin on polymorphonuclear leukocyte elastase and interleukin 6 levels after hepatectomy [Ｊ]. Clin Ther, 1994; 16(4)∶680.
6. Nunes FA, Kumar C, Chance B, et al. Chemiluminescent measurement of increased free radical formation after ischemia/reperfusion. Mechanism of free radical formation in the liver [Ｊ]. Dig Dis Sci, 1995; 40(5)∶1045.
7. Lichtman SN, Lemasters JJ. Role of cytokines and cytokineproducing cells in reperfusion injury to the liver [Ｊ]. Semin Liver Dis, 1999; 19(2)∶171.
8. Weissman C. The metabolic response to stress: an overview and update [Ｊ]. Anesthesiology, 1990; 73(2)∶308.
9. Stahl WM. Acute phase protein response to tissue injury [Ｊ]. Crit Care Med, 1987; 15(6)∶545.
10. Kehlet H. Stress free anaesthesia and surgery [Ｊ]. Acta Anaesthesiol Scand, 1979; 23(6)∶503.
  1. 1. Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [Ｊ]. Ann Surg, 1996; 224(2)∶155.
  2. 2. Tang ZY, Yu YQ, Zhou XD, et al. Surgery of small hepatocellular carcinoma. Analysis of 144 cases [Ｊ]. Cancer, 1989; 64(2)∶536.
  3. 3. Okuhama Y, Shiraishi M, Higa T, et al. Protective effects of ulinastatin against ischemiareperfusion injury [Ｊ]. J Surg Res, 1999; 82(1)∶34.
  4. 4. Aihara T, Shiraishi M, Hiroyasu S, et al. Ulinastatin, a protease inhibitor, attenuates hepatic ischemia/reperfusion injury by downregulating TNFalpha in the liver [Ｊ]. Transplant Proc, 1998; 30(7)∶3732.
  5. 5. Hamazaki K, Matsubara N, Yunoki Y, et al. Effects of ulinastatin on polymorphonuclear leukocyte elastase and interleukin 6 levels after hepatectomy [Ｊ]. Clin Ther, 1994; 16(4)∶680.
  6. 6. Nunes FA, Kumar C, Chance B, et al. Chemiluminescent measurement of increased free radical formation after ischemia/reperfusion. Mechanism of free radical formation in the liver [Ｊ]. Dig Dis Sci, 1995; 40(5)∶1045.
  7. 7. Lichtman SN, Lemasters JJ. Role of cytokines and cytokineproducing cells in reperfusion injury to the liver [Ｊ]. Semin Liver Dis, 1999; 19(2)∶171.
  8. 8. Weissman C. The metabolic response to stress: an overview and update [Ｊ]. Anesthesiology, 1990; 73(2)∶308.
  9. 9. Stahl WM. Acute phase protein response to tissue injury [Ｊ]. Crit Care Med, 1987; 15(6)∶545.
  10. 10. Kehlet H. Stress free anaesthesia and surgery [Ｊ]. Acta Anaesthesiol Scand, 1979; 23(6)∶503.