腹腔镜肝切除术中半肝血流阻断法与间歇性Pringle法对患者术后炎症指标及肝功能的影响  

Effects of Hemihepatic Vascular Control and Intermittent Pringle Maneuver on Postoperative Inflammatory Indexes and Liver Function in Patients Undergoing Laparoscopic Hepatectomy

作　　者：计雕 王新建 牛家增 王海量 JI Diao;WANG Xinjian;NIU Jiazeng;WANG Hailiang(Postgraduate Training Base,Jinzhou Medical University Weihai Central Hospital,Weihai 264400,China)

机构地区：[1]锦州医科大学威海市中心医院研究生培养基地,山东威海264400 [2]威海市中心医院胃肠外科,山东威海264400 [3]威海市中心医院肝胆外科,山东威海264400

出　　处：《中国医学创新》2024年第24期32-36,共5页Medical Innovation of China

摘　　要：目的:对比分析腹腔镜肝切除术中半肝血流阻断法(hemihepatic vascular control,HVC)和间歇性Pringle法(intermittent Pringle maneuver,IPM)对患者术后炎症指标及肝功能的影响。方法:回顾性分析威海市中心医院2021年1月—2023年6月收治的行腹腔镜肝切除术的60例患者,根据术中所采用肝血流阻断技术将其分为IPM组(n=32,应用IPM)和HVC组(n=28,应用HVC)。比较两组术中出血量、手术时间、总住院时间,以及炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)]和肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]。结果:两组手术时间、术中出血量及术后1 d CRP水平比较,差异均无统计学意义(P>0.05)。HVC组总住院时间短于对照组,术后1、2、5 d的WBC水平均低于IPM组,术后2、5 d的CRP水平均低于IPM组,术后当天及术后1、2 d ALT、AST水平均明显低于IPM组,差异均有统计学意义(P<0.05)。结论:腹腔镜肝切除术中HVC、IPM对术中出血量及手术时间无明显影响,但HVC可减轻患者术后炎症反应及肝功能损害,缩短住院时间,利于患者术后恢复。Objective:To compare and analyze the effects of hemihepatic vascular control(HVC)and intermittent Pringle maneuver(IPM)on postoperative inflammatory indexes and liver function in laparoscopic hepatectomy.Method:A total of 60 patients who underwent laparoscopic hepatectomy in Weihai Central Hospital from January 2021 to June 2023 were retrospectively analyzed,and they were divided into IPM group(n=32,applied IPM)and HVC group(n=28,applied HVC)according to the hepatic blood flow blocking technique adopted during the operation.Intraoperative bleeding volume,operation time,total hospital stay,inflammatory indexes[white blood cell count(WBC),C reactive protein(CRP)]and liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)]were compared between the two groups.Result:There were no significant differences in operation time,intraoperative bleeding volume and CRP level 1 day after operation between the two groups(P>0.05).The total hospital stay of HVC group was shorter than that of control group,and the levels of WBC 1,2 and 5 days after operation were lower than those of IPM group,the levels of CRP 2 and 5 days after operation were lower than those of IPM group,the levels of ALT and AST on the day after operation and 1 and 2 days after operation were significantly lower than those of IPM group,the differences were statistically significant(P<0.05).Conclusion:In laparoscopic hepatectomy,HVC and IPM have no obvious effect on the intraoperative bleeding volume and operation time,but HVC can reduce the postoperative inflammatory reaction and liver function damage,shorten the hospital stay and facilitate the postoperative recovery of patients.

关 键 词：腹腔镜肝切除术 半肝血流阻断 间歇性Pringle法 肝功能 炎症指标 

分 类 号：R735.7[医药卫生—肿瘤]