交替性区域入肝血流阻断在腹腔镜肝右前叶切除术中的应用分析  

Intermittent regional hepatic vascular inflow occlusion for laparoscopic right anterior sectionectomy

作　　者：杨雨[1] 陈晶[1] 陈卫波 孙冬林[1] 段云飞[1] Yang Yu;Chen Jing;Chen Weibo;Sun Donglin;Duan Yunfei(Department of Hepatopancreatobiliary Surgery,the Third Affiliated Hospital,Soochow University,Changzhou 213000,China)

机构地区：[1]苏州大学附属第三医院肝胆胰外科,常州213000

出　　处：《中华肝胆外科杂志》2020年第3期161-164,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81602054);江苏省第五期"333工程"培养资金(BRA2017118);常州市高层次卫生人才培养工程(2016CZBJ044)。

摘　　要：目的比较交替性区域入肝血流阻断与Pringle阻断在腹腔镜肝右前叶切除术中的应用效果和安全性。方法回顾分析苏州大学附属第三医院肝胆胰外科2014年1月至2018年12月连续行腹腔镜肝右前叶切除54例患者资料,其中男性27例,女性27例,年龄40~60岁。54例患者中交替性区域入肝血流阻断24例纳入交替阻断组,Pringle阻断30例纳入Pringle阻断组。比较两组术后肝功能指标、术中出血量、术中输血量、手术时间以及术后并发症等。结果Pringle阻断组术中出血量(534±42)ml、术中输血量(2.88±0.54)U,均高于交替阻断组(374±21)ml、(1.86±0.29)U,差异均有统计学意义(均P<0.05)。Pringle阻断组手术时间少于交替阻断组,差异有统计学意义(P<0.05)。两组均有2例发生CO2气体栓塞,交替阻断组2例中转开放。交替阻断组术后肝功能指标(除白蛋白)优于Pringle阻断组,术后住院时间少于Pringle阻断组,差异均有统计学意义(均P<0.05)。交替阻断组发生术后并发症6例(25.0%),Pringle阻断组8例(26.7%),两组术后并发症比较差异无统计学意义(P>0.05)。结论在腹腔镜肝右前叶切除术中,交替性区域入肝血流阻断能显著减少术中出血量,降低肝功能损伤,缩短术后住院时间,但对手术操作技巧要求更高,可逐步推广。Objective To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods From January 2014 to December 2018,54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery,the Third Affiliated Hospital,Soochow University were recruited into this study.The patients were 40 to 60 years old,and 27 were males and 27 females.Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients(the intermittent occlusion group).The remaining patients underwent Pringle’s maneuvre(the Pringle group).Postoperative liver function,intraoperative blood loss,intraoperative blood transfusion,operation time and postoperative complications between the two groups were compared.Results Intraoperative hemorrhage and blood transfusion of the Pringle group(534±42)ml,(2.88±0.54)U were significantly higher than the intermittent occlusion group(374±21)ml,(1.86±0.29)U(all P<0.05).The operation time of the Pringle group was significantly shorter than the intermittent occlusion group(P<0.05).Two patients developed CO2 embolism in each group,which led to 2 patients in the intermittent occlusion group being converted to open operations.Postoperative hepatic function(except albumin)of the intermittent occlusion group was significantly better than the Pringle group,while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group(all P<0.05).Six patients(25.0%)developed postoperative complications in the intermittent occlusion group versus 8(26.7%)in the Pringle group(P>0.05).Conclusion Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment,and shortened hospital stay.However,it required higher operation skills and it should gradually be promoted.

关 键 词：肝切除术 腹腔镜 血流阻断 肝功能 

分 类 号：R657[医药卫生—外科学]