Pringle联合IVC法在巨大肝血管瘤切除术中的应用效果分析  

Application effect of Pringle combined with IVC in resection of giant hepatic hemangioma

作　　者：石川[1] 常华[1] 豆松萌 李恒 Shi Chuan;Chang Hua;Dou Songmeng;Li Heng(Department of Hepatobiliary,Pancreatic and Spleen Surgery,Zhengzhou the Sixth People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第六人民医院肝胆胰脾外科,郑州450000

出　　处：《河南外科学杂志》2021年第6期30-33,共4页Henan Journal of Surgery

摘　　要：目的探讨Pringle联合肝下下腔静脉阻断(IVC)法在巨大肝血管瘤切除术中的应用效果。方法回顾性分析郑州市第六人民医院肝胆胰脾外科2017-10—2019-10行巨大肝血管瘤切除术的90例患者的临床资料,依据术中入肝血流阻断方法分为Pringle联合IVC组(观察组,47例)和Pringle组(对照组,43例)。比较2组患者的手术资料、术中各时点的CVP、HR水平,以及术后第1天、第3天、第7天的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)肝功能指标和并发症。结果观察组术中出血量、输血率均少(低)于对照组,差异有统计学意义(P<0.05);2组手术时间、入肝血流阻断时间、切除肝量差异无统计学意义(P>0.05)。观察组阻断肝血流后的CVP低于对照组,HR高于对照组;松开阻断带后观察组的CVP、HR基本恢复至阻断前水平,而对照组的CVP仍低于阻断前,差异有统计学意义(P<0.01)。观察组术后第3天、第7天的ALT、AST、TBIL水平均低于对照组,差异有统计学意义(P<0.01)。2组并发症发生率差异无统计学意义(P>0.05)。结论 Pringle联合IVC法,有助于减少肝脏巨大血管瘤切除术中的出血量,对患者血流动力学及肝功能的影响较小,是安全可行的控制肝切除术中出血的方法。Objective To explore the application effect of Pringle combined with inferior vena cava(IVC)in resection of giant hepatic hemangioma.Methods A retrospective analysis was performed on the clinical data of 90 patients undergoing resection of giant hepatic hemangioma in the Department of Hepatobiliary,Pancreatic and Spleen Surgery,Zhengzhou the Sixth People’s Hospital,between October 2017 and October 2019.According to hepatic inflow occlusion methods,they were divided into observation group(n=47,Pringle combined with IVC)and control group(n=43,Pringle).The surgical data,levels of central venous pressure(CVP)and heart rate(HR)during surgery,liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)]at 1d,3d and 7d after surgery,and complications were compared between the two groups.Results The intraoperative blood loss and blood transfusion rate in observation group were lower than those of control group(P<0.05).There was no significant difference in operation time,hepatic inflow occlusion time or resected liver volume between the two groups(P>0.05).After blocking hepatic blood flow,CVP in observation group was lower than that of control group,while HR was higher than that of control group.After the release of blockage band,CVP and HR in observation group were recovered to levels before blocking.However,CVP in control group was still lower than that before blocking(P<0.01).At 3d and 7d after surgery,levels of ALT,AST and TBIL in observation group were lower than those of control group(P<0.01).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Pringle combined with IVC is beneficial to reduce blood loss during the resection of giant hepatic hemangioma,with few effects on hemodynamics and liver function.It is a safe and feasible method to control bleeding during hepatectomy.

关 键 词：入肝血流 阻断 肝血管瘤切除术 应用 

分 类 号：R735.7[医药卫生—肿瘤]