3D腹腔镜下两种不同肝血流阻断技术在腹腔镜肝切除术中的应用比较  

Comparison of Application of Two Different Hepatic Blood Flow Occlusion Techniques under 3D Laparoscopy in Laparoscopic Hepatectomy

作　　者：卢超[1] 陈波 邢志祥 周鹏 王帅[1] LU Chao;CHEN Bo;XING Zhixiang(Jingzhou Central Hospital,Hubei Jingzhou 434020,China)

机构地区：[1]湖北省荆州市中心医院肝胆胰脾外科,湖北荆州434020

出　　处：《河北医学》2024年第11期1868-1873,共6页Hebei Medicine

基　　金：2019年度第一批联合基金立项项目,(编号:WJ2019H222)。

摘　　要：目的:对比分析3D腹腔镜下区域性入肝血流阻断法和间歇性全入肝血流阻断法在腹腔镜肝切除术(LH)治疗原发性肝癌(PLC)患者术后恢复情况。方法:选择109例(2023年3月至2024年3月)PLC患者进行研究,均接受LH手术治疗,将使用区域性入肝血流阻断法的54例患者作为研究的观察组,将使用间歇性全入肝血流阻断法的55例患者作为研究的对照组。对比分析围手术期指标,统计手术治疗之前、手术结束后3d的肝功能指标和胃肠功能指标变化情况。结果:观察组手术操作及治疗时间、手术期间出血情况、肝血流阻断时间和整体住院时间均低于对照组(P<0.05);观察组经3个月随访后,并发症发生率为3.70%,低于对照组的18.18%(P<0.05)。观察组经手术治疗结束后3d血清ALT、AST、TBIL、DBIL水平与术前相比的差值小于对照组(P<0.05);观察组经手术治疗结束后3d血清GAS含量、血浆MTL水平与术前相比的差值小于对照组(P<0.05)。结论:与PLC患者使用3D腹腔镜下区域性入肝血流阻断法治疗相比,间歇性全入肝血流阻断法手术时间短、术中出血量相对较少、无血流阻断时间,同时可缩短住院时间,这可能与该手术对术后肝功能和胃肠功能影响较小有关。Objective:To compare and analyze the postoperative recovery status of 3D laparoscopic regional hepatic blood flow occlusion and intermittent total hepatic blood flow occlusion in patients with PLC treated by LH.Methods:A total of 109 PLC patients(from March 2023 to March 2024)were selected for the study,all of whom received LH surgical treatment.54 patients using regional hepatic blood flow obstruction were classified as the observation group,and another 55 patients who adopted intermittent total hepatic blood flow obstruction were set as the control group.The perioperative indexes were compared and analyzed,and the changes of liver function indexes and gastrointestinal function indexes[serum gastrin(GAS),plasma motilin(MTL)]before surgery and at 3 days after the surgery were statistically analyzed.Results:Operation and treatment time,bleeding status during surgery,hepatic blood flow occlusion time and overall hospital stay in the observation group were shorter or lower(P<0.05).After 3 months follow-up,the incidence of complications in the observation group(3.70%)was lower than that in the control group(18.18%)(P<0.05).The difference of serum ALT,AST,TBIL,DBIL levels between pre-operation and post-operation in observation group were less than that in control group(P<0.05);the difference of serum GAS content and plasma MTL level between pre-operation and post-operation in observation group were less than in control group(P<0.05).Conclusion:Compared with 3D laparoscopic regional hepatic blood flow occlusion in the treatment of PLC patients,intermittent total hepatic blood flow occlusion has shorter surgical time,less intraoperative blood loss and no blood flow occlusion time,and the latter one can better shorten the hospitalization time,which may be related to the small influence of the surgery on postoperative liver function and gastrointestinal function.

关 键 词：原发性肝癌 区域性入肝血流阻断法 腹腔镜肝切除术 间歇性全入肝血流阻断法 肝功能 胃肠功能 

分 类 号：R735.7[医药卫生—肿瘤]