半肝入肝血流阻断联合CLCVP对腹腔镜肝切除术患者组织灌注及肝肾功能影响研究  

Effect of hemihepatic transhepatic occlusion combined with CLCVP on tissue perfusion and hepatorenal function of patients undergoing laparoscopic hepatectomy

作　　者：康焕菊[1] 曹苏[1] 王敬春[1] 王雷[1] 刘学 Kang Huanju;Cao Su;Wang Jingehun;Wang Lei;Liu Xue(The Affiliated Hospital of Nantong University,Nantong Jiangsu Province 226001,China;The Third Affilialed Hospital of the Naval Mililary Medical University,Shanghai 201805,China)

机构地区：[1]南通大学附属医院,江苏南通226001 [2]海军军医大学第三附属医院,上海201805

出　　处：《中华普外科手术学杂志（电子版）》2022年第4期427-430,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2019年度江苏省预防医学课题(Y2019102)。

摘　　要：目的研究半肝入肝血流阻断联合控制性低中心静脉压(CLCVP)对腹腔镜肝切除术患者肝组织灌注及肝肾功能影响。方法回顾性分析2018年6月至2020年12月100例行腹腔镜肝切除术患者资料,根据术中是否联合CLCVP技术分为两组,CLCVP组及对照组各50例。临床数据分析使用统计学软件SPSS 24.0,围手术期指标、术中血流动力学、术中乳酸水平、手术前后肝肾功能等计量资料采用(x±s)表示,采用独立样本t检验;计数资料采用χ^(2)检验。以P<0.05为差异有统计学意义。结果CLCVP组手术时间、术中出血量、肝门阻断时间及术中输血例数均少于对照组(P<0.05)。肝脏离断前及肝脏离断后5min,CLCVP组中心静脉压(CVP)平均动脉压(MAP)明显低于对照组(P<0.05)。肝门阻断时及肝脏离断后,两组患者乳酸水平均较前一时间点明显增高,且CLCVP组明显高于对照组(P<0.05)。术后1 d两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、血肌酐(Ser)、尿素氮(BUN)均较前明显增高(P<0.05)。结论半肝入肝血流阻断后应用CLCVP技术可有效控制腹腔镜肝切除术中出血量,缩短手术时间,减少输血率,虽然可致术中乳酸水平升高,但对肝肾功能无明显影响。Objective To invetigate the effects of hemihepatic blood flow ocdusion combined with contolled low central venous pressure(CLCVP)on hepatic issue perfusion and hepalorenal function in patients undergoing laparoscopic hepaltctomy.Methods Data of 100 patients undergoing laparoscopic hepatectomy from June 2018 to December 2020 were retrospectively analyzed.They were divided into two groups acording to whether CLCVP was combined with intraoperative healectomy,with 50 patients in CLCVP group and 50 patients in control goup.Saistical software SPSS 24.0 was used for dinical data analysis.Perioperative indicators,intraoperative hemodynamics,intraoperative lactic acid level,liver and kidney function before and alfter surgery were expressed by(x±s),and independent t test was used.Staistial data were tested by χ^(2) test.P<0.05 was considered as stistcally significant diference.Results The operative time,intraoperative blood loss,hilar occlusion time and intraoperative blood transfusion cases in CLCVP group were all shorter than those in control group(P<0.05).Before and 5 min after liver isection,the central venous pressure(CVP)and mean arterial pesure(MAP)in CLCVP goup were sigifcantly lower than those in control group(P<0.05).After hilar oclusion and liver dseetion,the lactie arid lerel in both groups was signifrcantly higher than that in the previus time point,and that in CLCVP group was sigificanly higher than that in the control grup(P<0.05).1 d afer surgery,ALT,AST,TBIL,Ser and BUN in 2 groups were signfcantly higher than before(P<0.05).Conclusion The application of CLCVP after hemihepatice blood inlow oclusion cean effectively control the amount of blood loss,shorten the operation time and reduce the rate of blood trasfusion in laparoscopic hepalectonmy.Although it may increase the itnapenative lactic acid level,it has no obvious effect on the liver and kidney function.

关 键 词：肝切除术 腹腔镜 半肝入肝血流阻断 控制性低中心静脉压 组织灌注 肝肾功能 

分 类 号：R54[医药卫生—心血管疾病]