三种肝血流阻断术的左半肝切除术治疗原发性肝癌的对比研究  

Comparative research of laparoscopic left hemi-hepatectomy by using three different techniques of hepatic blood flow occlusion in treating primary liver cancer

作　　者：李依川 彭彬[1] 辛大平 刘洪恩 王麒智 唐伟刚 Li Yichuan;Peng Bin;Xin Daping;Liu Hongen;Wang Qizhi;Tang Weigang(Department of hepatobiliary surgery,Guang’an people’s Hospital,Sichuan 638000,China)

机构地区：[1]广安市人民医院肝胆外科,四川广安638000

出　　处：《中华普外科手术学杂志（电子版）》2021年第5期566-569,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：重庆市第四批科研项目计划(cstc2019jscx-msxmX0413);重庆市卫计委重点项目(2017ZDXM027)。

摘　　要：目的对比腹腔镜下三种不同肝血流阻断术对左半肝切除治疗原发性肝癌围术期指标及并发症的影响。方法回顾性分析2017年1月至2020年3月接受腹腔镜左半肝切除术(LLH)治疗的100例肝癌患者资料,按照不同肝血流阻断方式将其分为A组(Pringle法,41例),B组(半入肝血流阻断,32例),C组(选择性入肝血流阻断,27例)。采用SPSS20.0软件处理数据,围术期相关指标、肝功能指标等计量资料以(±s)表示,三组间比较采用F检验;并发症发生率比较采用卡方检验。P<0.05为差异有统计学意义。结果三组间手术中转开腹率、手术时间与输血率比较差异均无统计学意义(P>0.05);术中平均阻断时间A组<B组<C组,术中出血量、住院时间A组>B>C两组(P<0.05)。A组患者术后1、3、7 d凝血酶原时间(PT)、、谷丙转氨酶(ALT)、总胆红素(TBIL)水平均高于B、C两组(P<0.05),白蛋白(ALB)均低于B、C两组(P<0.05);A组术后总并发症发生率显著高于C组(P<0.05)。结论在LLH治疗原发性肝癌采用半肝血流阻断加肝静脉阻断术在控制术中出血和术后恢复方面有优势,其对肝脏损伤较小,术后肝功能恢复更快,可减少术后并发症的发生。Objective To compare the therapeutic effects of perioperative indexes and complications after laparoscopic left hemihepatectomy by using three different techniques of hepatic blood flow occlusion in treating primary liver cancer.Methods The clinical data of 100 patients with liver neoplasms who received laparoscopic left hemihepatectomy(LLH)from January 2017 to March 2020 was analyzed retrospectively.Including 41 cases of pringle blocking of hepatic blood flow,were divided into group A,32 cases of hemihepatic blood flow blocking were divided into group B and 27 cases of selective hepatic blood flow blocking,were divided into group C.Statistical analysis were performed by using SPSS20.0 software,Measurement data such as perioperative related index and liver function index were expressed as,the difference between three groups were examined by using F test;The incidence of complications was examined by using chi-square test.A P value of<0.05 was considered as statistically significant difference.Results There was no significant difference between three groups in terms of conversion rate operation time and blood transfusion rate(P>0.05).The average intraoperative time in group A<group B<group C,intraoperative blood loss and the length of hospitliztion in group A>group B>group C(P<0.05)were observed respectively.On day 1,3 and 7 after surgery,The serum PT,ALT and TBIL levels in group A were significantly higher than those in group B and C(P<0.05),and the serum ALB of group A was much lower than those in group B and C(P<0.05).The incidence of postoperative complications in group A was significantly higher than that in group C(P<0.05).Conclusion In the LLH treatment for primary liver neoplasms,hemihepatic blood flow occlusion combined with hepatic vein occlusion could achieve better control of intraoperative bleeding and postoperative recovery,with less injury of the liver,faster postoperative recovery of liver function,and with reduced occurrence of postoperative complications.

关 键 词：肝肿瘤 肝切除术 腹腔镜 全入肝血流阻断 半肝血流阻断 半肝血流阻断加肝静脉阻断 疗效比较研究 

分 类 号：R735.7[医药卫生—肿瘤]