巨大肝血管瘤切除术中两种入肝血流阻断方法对患者血流动力学及肝功能的影响比较  

Comparison of The Effects of Two Methods of Hepatic Blood Flow Occlusion on Hemodynamics and Liver Function in Patients with Giant Hepatic Hemangioma

作　　者：王越市 武洋 WANG Yueshi;WU Yang(Pingmei Shenma Medical Group General Hospital,Pingdingshan,467000)

机构地区：[1]平煤神马医疗集团总医院,467000

出　　处：《实用癌症杂志》2024年第5期867-870,共4页The Practical Journal of Cancer

摘　　要：目的比较巨大肝血管瘤切除术中Pringle阻断法与Glisson鞘外阻断法对患者血流动力学及肝功能的影响,为优化巨大肝血管瘤切除术中入肝血流阻断方法提供参考。方法本研究为回顾性研究,收集2019年1月至2022年12月医院收治的108例行腹腔镜巨大肝血管瘤切除术患者的临床资料。依据术中入肝血流阻断方法的不同,将其中50例行Pringle阻断法患者的临床资料纳入A组,将其余58例行Glisson鞘外阻断法患者的临床资料纳入B组。统计2组患者围手术期指标(手术时间、血流阻断时间、术中出血量、住院时间),比较2组患者入肝血流阻断前(T_(0))、血流阻断后15 min(T_(1))、术毕时(T_(2))的血流动力学指标[心率(HR)、平均动脉压(MAP)];术前及术后d3、d7时肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)]。分析2组患者术后并发症发生情况。结果2组手术时间、血流阻断时间比较,差异无统计学意义(P>0.05);B组术中出血量少于A组,住院时间短于A组,差异均有统计学意义(P<0.05)。2组T_(1)、T_(2)时HR、MAP均较T_(0)时提高,但B组T_(1)、T_(2)时HR、MAP均低于A组,差异均有统计学意义(P<0.05)。术前及术后d3、d7,2组血清ALT、AST、TBIL水平呈先升高后降低趋势,且B组上述指标水平均低于A组,差异有统计学意义(P<0.05)。2组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论与Pringle阻断法比较,巨大肝血管瘤切除术中行Glisson鞘外阻断可有效减少患者术中出血量,缩短住院时间,对患者血流动力学及肝功能的影响较小。Objective To compare the effects of Pringle block method and Glisson sheath block method on hemodynamics and liver function in patients with giant hepatic hemangioma resection,and provide reference for the optimization of hepatic blood flow block method in giant hepatic hemangioma resection.Methods This study was a retrospective study.The clinical data of 108 patients underwent laparoscopic resection of giant hepatic hemangioma were collected.According to the different methods of intraoperative hepatic blood flow occlusion,the clinical data of 50 patients with Pringle block method were included in Group A,and the clinical data of the remaining 58 patients with Glisson sheath block method were included in Group B.The perioperative indexes of patients in the 2 groups[operation time,blood flow blocking time,intraoperative blood loss,and hospitalization time]were counted,and the hemodynamic indexes[heart rate(HR),mean pulse pressure(MAP)]of patients in the two groups before liver blood flow blocking(T_(0)),15 minutes after blood flow blocking(T_(1)),and at the end of operation(T_(2))were compared.Liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)]were measured before operation,3 days and 7 days after operation.The postoperative complications of the 2 groups were analyzed.Results There was no statistical significant difference in the operation time and blood flow blocking time between the 2 groups(P>0.05).The amount of intraoperative bleeding in group B was less than that in group A,and the length of hospitalization was shorter than that in group A,with a statistical significant difference(P<0.05).HR and MAP at T_(1) and T_(2) in both groups were higher than that at T_(0),and HR and MAP at T_(1) and T_(2) in Group B were lower than those in Group A,with a statistical significant difference(P<0.05).The levels of serum ALT,AST and TBIL in the 2 groups increased and then decreased before and 3 and 7 days after operation,and the levels of the above indicators in Grou

关 键 词：肝血管瘤 肝血管瘤切除术 Pringle阻断法 Glisson鞘外阻断法 肝功能 

分 类 号：R735.7[医药卫生—肿瘤]