不同入肝血流阻断技术下腹腔镜肝切除术治疗原发性肝癌患者近期效果研究  

Different hepatic inflow occlusion techniques during laparoscopic hepatectomy in treatment of patients with primary liver cancer

作　　者：范明 杨龙 金亮 周景师 Fan Ming;Yang Long;Jin Liang(Department of Hepatobiliary,Pancreatic and Splenic Surgery,First Affiliated Hospital,Air Force Military Medical University,Xi'an 710032,Shaanxi Province,China)

机构地区：[1]空军军医大学第一附属医院肝胆胰脾外科,西安市710032

出　　处：《实用肝脏病杂志》2024年第1期101-104,共4页Journal of Practical Hepatology

基　　金：陕西省重点研发计划项目(编号:2023-YBSF-226)。

摘　　要：目的探讨不同入肝血流阻断技术腹腔镜肝切除术(LH)治疗原发性肝癌(PLC)患者的效果。方法2021年2月~2022年11月我院收治的PLC患者132例,均行LH术治疗。术中,69例观察组采用区域性入肝血流阻断,对照组63例采用间歇性全入肝血流阻断。常规测量心率(HR)和平均动脉压(MAP),使用超声检测门静脉血流速度(PVV)。结果观察组手术输血率、手术时间和住院日分别为15.9%、(240.3±42.9)min和(14.7±2.3)d,与对照组【分别为19.1%、(231.7±39.5)min和(15.0±2.9)d】比,无统计学差异(P>0.05),而观察组肝血流阻断时间为(0.0±0.0)min,显著短于对照组【(26.8±7.1)min,P<0.05】,术中出血量为(301.2±52.5)mL,显著少于对照组【(369.8±59.4)mL,P<0.05】;在术后7 d,观察组HR、MAP和PVV分别为(79.1±7.2)次/min、(80.7±3.6)mmHg和(21.3±2.0)cm/s,与对照组【分别为(78.9±6.8)次/min、(81.9±4.1)mmHg和(20.9±1.9)cm/s】比,无统计学差异(P>0.05);观察组血清总胆红素水平为(18.4±3.5)μmol/L,显著低于对照组【(24.9±5.7)μmol/L,P<0.05】,而白蛋白水平为(35.3±5.4)g/L,显著高于对照组【(32.0±4.6)g/L,P<0.05】;术后,两组腹腔积液、切口感染、胆汁漏、肺部感染和腹腔出血等并发症发生率无显著性差异(2.9%对3.2%,P>0.05)。结论在行LH手术时,采用入肝血流阻断技术安全有效,但采取区域性入肝血流阻断能缩短肝血流阻断时间,减少术中出血量,对术后肝功能损伤较轻。Objective The aim of this study was to investigate different hepatic inflow occlusion techniques during laparoscopic hepatectomy(LH)in treatment of patients with primary liver cancer(PLC).Methods A total of 132 patients with PLC were encountered in our hospital between February 2021 and November 2022,and all underwent LH.They were divided into observation(n=69),and control group(n=63),received regional hepatic inflow occlusion or intermittent total hepatic inflow occlusion during LH.The heart rate(HR)and mean arterial pressure(MAP)were routinely measured,and the portal vein peak velocity(VPV)was detected by ultrasonography.Results There was no significant differences as respect to blood transfusion rate,operation time and hospitalization stay[15.9%,(240.3±42.9)min and(14.7±2.3)d vs.19.1%,(231.7±39.5)min and(15.0±2.9)d,P>0.05]between the observation and control group,while the hepatic flow occlusion time in the observation group was significantly shorter than that in the control group[(0.0±0.0)min vs.(26.8±7.1)min,P<0.05],and the intraoperative blood loss was significantly less than that in the control group[(301.2±52.5)mL vs.(369.8±59.4)mL,P<0.05];there was no significant differences between the two groups respect to the HR,MAP and PVV[(79.1±7.2)beats/min,(80.7±3.6)mmHg and(21.3±2.0)cm/s vs.(78.9±6.8)beats/min,(81.9±4.1)mmHg and(20.9±1.9)cm/s,P>0.05]at day seven after surgery;serum total bilirubin level in the observation group was significantly lower than that in the control group[(18.4±3.5)μmol/L vs,(24.9±5.7)μmol/L,P<0.05],while serum albumin level was significantly higher than that in the control group[(35.3±5.4)g/L vs.(32.0±4.6)g/L,P<0.05];all patients were followed-up for 1 month after surgery,and there was no significant difference between the two groups as respect to the incidence of ascites,incision infection,bile leakage,pulmonary infection and abdominal bleeding(2.9%vs.3.2%,P>0.05).Conclusion The two hepatic inflow occlusion techniques are both safe and effective during the LH opera

关 键 词：原发性肝癌 入肝血流阻断 腹腔镜肝切除术 并发症 治疗 

分 类 号：R735.7[医药卫生—肿瘤]