【摘要】：目的:探討標(biāo)準(zhǔn)殘肝體積(standard remnantliver volume,SRLV)、膽堿酯酶(cholinesterase,CHE)、γ-谷氨酰轉(zhuǎn)肽酶(gamma-glutamyl transferase,GGT)、堿性磷酸酶(alkal inephosphates,ALP)、肝硬化(liver cirrhosis,LC)對于泡型肝包蟲病患者行肝切除術(shù)后肝儲備功能的影響程度,并進(jìn)一步證實(shí)該因素與肝功能代償不全的關(guān)系。方法:對青海省人民醫(yī)院普外科2013-03/2015-3收治的60例泡型肝包蟲病患者行肝切除術(shù),通過測定TLV、SRLV、CHE、GGT、ALP的值及有無LC,采用多因素Logistic回歸方程,分析SRLV、CHE、GGT、ALP及LC對泡型肝包蟲病患者肝切除術(shù)后對于肝臟儲備功能的影響及其大小。使用受試者操作曲線分析,得出影響肝儲備功能指標(biāo)對肝功能不全的預(yù)測價(jià)值及臨界值,并計(jì)算出該臨界值導(dǎo)致肝功能不全的發(fā)生率。結(jié)果:術(shù)前導(dǎo)致泡型肝包蟲病患者肝儲備功能下降的因素為LC、肝臟的總體積(totalliver volume,TLV)、GGT(P0.05),OR值分別為為2.484、0.2796、1.0000。而術(shù)后肝儲備功能下降的因素為為LC、SRLV、GGT(P0.05),其中LC影響最大,OR值為6.7848。其次為SRLV、GGT,OR值分別為1.00002、1.00031。SRLV對預(yù)測肝功能不全的臨界值為498.50ml/m2,GGT對預(yù)測肝功能不全的臨界值97.5U/L。當(dāng)SRLV498.50ml/m2時(shí),肝功能不全發(fā)生率為50%,當(dāng)GGT97.5U/L時(shí),肝功能不全發(fā)生率為45.5%。CHE和ALP對泡肝患者手術(shù)前后的肝儲備功能均無明顯影響,手術(shù)因素導(dǎo)致泡型肝包蟲患者術(shù)后肝儲備功能下降。結(jié)論:影響青海地區(qū)泡型肝包蟲患者肝儲備功能的因素依次為LC、SRLV、GGT�；颊咝g(shù)后儲備功能明顯低于術(shù)前,導(dǎo)致肝儲備功能下降的因素可引起肝功能代償不全。
[Abstract]:Objective: to investigate standard residual liver volume (standard remnantliver volume,SRLV), cholinesterase (cholinesterase,CHE), 緯 -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.
【學(xué)位授予單位】：青海大學(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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