三种肝血流阻断技术在腹腔镜下肝切除术中的对比研究  

Comparative study of three hepatic blood flow blocking techniques in laparoscopic hepatectomy

作　　者：张安清 东爱华 李红霞 李爱华 Zhang Anqing;Dong Aihua;Li Hongxia;Li Aihua(Department of General SurgeryⅢ,Chengdu Shangjin Nanfu Hospital/Sichuan University West China Hospital Shangjin Hospital,Chengdu Sichuan Province 610000,China)

机构地区：[1]成都上锦南府医院/四川大学华西医院上锦医院普外3科,成都610000

出　　处：《中华普外科手术学杂志（电子版）》2022年第3期323-326,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省医学科研课题立项项目(S19019);2020年四川青年创新科研课题(Q20060)。

摘　　要：目的对比研究三种肝血流阻断技术在腹腔镜下肝切除术中的临床效果,分析三种技术对肝癌患者机体氧化应激损伤及肝肾功能的影响。方法回顾性分析2017年1月至2021年1月143例肝癌行腹腔镜下肝切除术患者的临床资料,根据不同血流阻断方法将患者分为A组(Pringle法阻断入肝血流,n=59例)、B组(改良Pringle法阻断入肝血流,n=33例)和C组(改良Pringle法阻断人肝血流+下腔静脉阻断法,n=51例)。采用SPSS22.0统计学软件进行数据分析,围手术期各项指标、氧化应激指标、肝肾功能指标以(x±s)表示,多组间比较采用单因素方差分析,两组间比较采用t检验;术后并发症等计数资料采用x或Fisher精确检验。以P<0.05为差异有统计学意义。结果C组患者术中出血量及输血量均明显少于A、B组(P<0.05)。三组患者术后并发症发生率比较差异无统计学意义(P>0.05)。术后3 d.7 d患者的超氧化物歧化酶水平C组高于A、B组(P<0.05);术后1d\3d患者的丙二醛水平C组明显低于A、B组(P<0.05);术后1d.3d患者的谷胱甘肽过氧化物酶水平C组高于A、B组(P<0.05)。术后1d、3d、7dC组患者的谷丙转氨酶、谷草转氨酶、总胆红素水平均明显低于A组(P<0.05);三组患者术后肌酐及尿素氮水平差异无统计学意义(P>0.05)。结论改良Pringle法联合肝下下腔静脉阻断法可减少肝癌患者术中出血量,且对患者机体氧化应激损伤及肝功能损伤较小。Objective The clinical effects of three hepatic blood flow occlusion techniques in laparoscopic hepatectomy were compared to analyze the effects of the three techniques on oxidative stress injury and liver and kidney function in patients with liver cancer.Methods The clinical data of 143 patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy from January 2017 to January 2021 were retrospectively analyzed.According to different blood occlusion methods,the patients were divided into group A(hepatic blood flow occlusion by Pringle method,n=59 cases)and group B(hepatic blood flow occlusion by modified Pringle method,n=33 cases)and C group(improved Pringle method+inferior vena cava method,n=51 cases).SPSS 22.0 statistical software was used for data analysis.Perioperative indicators,oxidative stress indicators and liver and kidney function indicators were expressed as(x±s).One-way ANOVA was used for multi-group comparison and t test was used for comparison between two groups.Postoperative complications were measured by X'or Fisher's exact test.P<O.05 was considered as statistically significant difference.Results The amount of intraoperative blood loss and blood transfusion in group C were significantly less than those in groups A and B(P<O.05).There was no significant difference in the incidence of postoperative complications among the three groups(P>O.05).The level of superoxide dismutase in group C was higher than that in groups A and B at 3 and 7 days after operation(P<O.05).The level of malondialdehyde in group C was significantly lower than that in group A and B at 1 and 3 days after operation(P<O.05).The level of glutathione peroxidase in group C was higher than that in groups A and B at 1 and 3 days after operation(P<O.05).The levels of alanine aminotransferase,aspartate aminotransferase and total bilirubin in group C were significantly lower than those in group A at 1,3 and 7 days after operation(P<O.05).There were no significant differences in postoperative creatinine and urea nitrogen lev

关 键 词：肝切除术 腹腔镜 人肝血流阻断 氧化应激 肝功能 

分 类 号：R73[医药卫生—肿瘤]