Clinical Study On The Recovery Of Early Hepatic Dysfunction After Hepatectomy By Remote Ischemic Treatment

Objectives:To explore the role of remote ischemic treatment in promoting the re-covery of early hepatic dysfunction in patients after hepatectomy,and whether it can reduce the liver ischemia-reperfusion injury,and to explore the possible mechanism,so as to provide a protective method for clinical work.Methods:From September 2017 to September 2019,41 patients with liver tumors were randomly divided into two groups:experimental group:the first day,the second day and the third day after hepatectomy were treated with tourniquet on one side of the upper limb,inflated to a pressure of 26.6kpa(about 200mmhg)to block the upper limb blood flow,maintained for 5min,deflated to 0kpa(about 0mmhg),opened for 5min,and circulated for three times;control group:on the 1st,2nd and 3rd day after hepatectomy,the patient's upper limb was tied with tourniquet without inflation and deflation.There was no significant difference between the two groups in general clinical data(age,gender,tumor size,liver cirrhosis,portal vein thrombosis,operation time,intraoperative hemorrhage,preoperative liver function grade,etc.).The recovery of ALT,AST and TBIL were compared between the two groups.Results:(1)The changes of serum ALT,AST and TBIL in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups,and there was no significant difference in the number of days in hospital.(2)For patients with liver cirrhosis,the changes of serum ALT,AST and TBIL in the two groups were as follows:the serum ALT and AST in the experimental group were significantly lower than those in the control group on the first,third and seventh days after hepatectomy respectively(P<0.05);the serum TBIL in the third day after operation was lower than that in the control group(P<0.05),and there was no significant difference between the two groups on the first and seventh days after hepatectomy(P>0.05).This possible mechanism is that the decline of bilirubin level in experimental group was relatively slow in cirrhotic patioents or long-term accumulation and metabolism of bilirubin in patients with cirrhosis are related.Conclusions:Remote ischemic treatment after hepatectomy could reduce the occurrence of ischemia-reperfusion injury,and so as to promote the recovery of early hepatic dysfunction.