不同入肝血流阻断在腹腔镜肝切除术应用比较  

Comparison of pringle maneuver and selective hepatic vascular control in laparoscopic hepatectomy

作　　者：晏益核[1] 卢榜裕[1] 蔡小勇[1] 黄玉斌[1] 靳小建[1] 雷宇[1] 陈永军[1] 李建军[1] 

机构地区：[1]广西医科大学第一附属医院微创外科,广西南宁530021

出　　处：《中国内镜杂志》2012年第7期673-677,共5页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜肝切除术(LH)中不同入肝血流阻断的差异。方法回顾性分析95例LH,根据术中血流阻断方式分为:A组(39例)全入肝血流阻断(Pringle法),B组(56例)选择性入肝血流阻断。比较两组手术时间、术中出血及输血量,术后肝功能及血常规,术后住院天数、并发症及肝癌复发率、生存率。结果两组术前临床特征比较差异无显著性(P>0.05),手术时间、术中出血及输血量比较差异无显著性(P>0.05)。A组术后1d血清谷丙转氨酶及谷草转氨酶水平高于B组(P<0.05),术后1～5d前白蛋白水平低于B组(P<0.05),而胆红素、白蛋白、血常规比较差异无显著性(P>0.05)。术后住院天数,并发症,1、2年复发率及3年生存率比较差异无显著性(P>0.05)。结论选择性阻断在控制断肝过程出血的效果与Pringle法相同,并且对肝功能保护优于Pringle法;但术中肝门大血管意外损伤的腔镜下修复仍需要采用Pringle法。[ Objective ] To compare the different methods of hepatic vascular control in laparoscopic hepatecto- my （LH）. [ Methods ] Retrospective study was conducted to compares the perioperative and postoperative outcomes of 95 cases of LH between with the intermittent Pringle maneuver and with the selective vascular control. The out- come parameters include operative time, bleeding, transfusion volume, complications, hospital stay period, liver func- tion tests, routine blood tests, postoperative recurrence and survival rate of liver cancer. [ Results ] No significant difference existed between the two groups. Compared the results of LH either the intermittent Pringle maneuver or selective vascular clamping, ALT and AST levels from Pringle maneuver group were significant higher than those of selective vascular clamping group （P 〈0.05）; prealbumin （PA） level was significant lower in the Pringle maneuver group at first five days postoperation （P 〈0.05）. No significant difference existed in the other perioperative and post- operative outcomes of the two groups （P 〉0.05）. [ Conclusions ] The technique of selective vascular control can pro- tect liver function better than Pringle maneuver. But Pringle maneuver is still necessary in special condition such as repairing portal vein injury in LH.

关 键 词：腹腔镜 肝切除 肝门阻断 

分 类 号：R657.3[医药卫生—外科学]