| Objective: in the modern surgical clinic,liver and biliary tract surgery have great effect on liver function.With the extensive development of laparoscopy and the application of high-energy surgical instruments,electrical injury in liver surgery has become an increasingly important issue for hepatobiliary surgeons.Under the background of rapid rehabilitation surgery,how to make the patients recover quickly after operation is a new topic.Derected by the concept of fast-track surgery(FTS),This research made animal experiments in rats model,adopt perioperative interventions,the preoperative and postoperative standardization were given medicine treatment and combined use of Gexia Zhuyu Decoction treatment,to cure liver injury caused by electric heating.Changes in liver enzymology as observation indexes,to statistical analysis and evaluation of the results of the study,to observe the perioperative application under the Gexia Zhuyu Decoction in liver electrical injury rapid rehabilitation effect,explore application advantages in the field of FTS of traditional Chinese medicine.Methods: 40 healthy male SD rats were selected for randomized controlled trial,and divided into 4 groups by weight.Respectively: A :blank group,B:model group,C:atomolam group,and D:Gexia Zhuyu Decoction group.A group was only treated with skin incision and suture,and no electrocoagulation was performed to burn the liver,which was a sham group.In the other three groups,the model of liver injury was made by using high frequency electrocoagulator in the method of electrocoagulation.Perioperative intervention was performed in group B: preoperative and postoperative routine feeding,without drug intervention.Group C: treated by reduced glutathione tablet in preoperation and postoperation.Group D : treated by Gexia Zhuyu Decoction combined with reduced glutathione tablet in preoperation and postoperation.The intervention time was 2 weeks before and 1 week after surgery.Observe each group rats general growth,and 1 day before the beginning of the intervention,preoperative 1 day,postoperative day 1,day 3,7 days to determine each alanine aminotransferase(ALT),aspertate aminotransferase(AST),gamma glutamyl transpeptidase(GGT),serum total bilirubin(TBIL).After the experiment,the animal was killed,and the liver tissue pathology section was made,HE staining,and the liver tissue morphology was observed under the microscope,and the damage of liver tissue structure in the four groups was compared.The experimental results were summarized and statistical analysised to understand the change trend of hepatic injury indexes before and after the operation of each group,and the data of each group were compared dynamically to observe the damage effect of the electrocoagulation apparatus on the liver.And by way of contrast between groups,to understand perioperative interventions influence on liver injurybiochemical indicators,to observe the perioperative application of Gexia Zhuyu Decoction to the influence and effect of liver injury recovery time.Results: the postoperative general activity status,diet and color of the model mice were poor.In the first day after surgery,the indexes of liver injury in group B,C and D were significantly increased,and ALT,AST,GGT and TBIL were significantly higher than those in the blank group.The model is successful.Comparison between groups,perioperative drug intervention group rats,each index of group C,D is lower than group B,there was no statistically significant difference in GGT of group B and C,other differences were statistically significant(P < 0.05).Among them,all the indicators in group D were lower than that of group C,and the ALT difference was statistically significant(P<0.05).Test results after 3 days,the rats biochemical index gradually decline,including C,D group of ALT,AST,GGT,TBIL values were lower than group B,the difference was statistically significant(P < 0.05),group D all the indicators are lower than group C,besides TBIL,differences were statistically significant(P < 0.05).Postoperative day 7 test results,the rats biochemical indicators fall further,C,D group’s ALT,AST,GGT,TBIL values were lower than group B,the difference was statistically significant(P < 0.05),group D all the indicators are lower than group C,ALT,AST difference was statistically significant(P <0.05).The indexes of group D were close to the normal level of group A,and the difference was not statistically significant(P>0.05).After HE staining of liver biopsy,the results showed that the liver tissue cells in group A were arranged neatly and the structure of hepatic lobules was obvious and normal.Group C,group D rat liver central vein expansion,mild-to-moderate edema,liver cell volume increase,narrow liver blood sinus pressure,portal area slightly expansion blood vessel,with red blood cell infiltration,hepatic tissue injury is lighter,the blood stasis.In group B,rat hepatocytes were significantly edema,with obvious denaturation necrosis,with a large range,with necrotic cells and inflammatory cells infiltrating in the surrounding central vein,with a severe degree of damage.Conclusion: 1.The application of high energy devices in hepatobiliary surgery,its electrocautery damage is obvious to liver tissue damage,causing the liver function to decrease,and liver cell damage related biochemical indexes are elevated.2.The use of protective liver drugs during perioperative period can significantly reduce liver injury and promote the recovery of liver function.3.During the perioperative period,the combined application of Gexia Zhuyu Decoction had significantly reduced and promoted the recovery of liver injury in rats,and the therapeutic effect was better than that of glutathione.4,under the guidance of rapid rehabilitation surgery concept,perioperative application of traditional Chinese medicine(TCM)in promoting rapid postoperative recovery ",the mechanism of action of traditional Chinese medicine and its effective ingredient to improve liver function is needed and deserved to study. |
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