不同入肝血流阻断方法用于腹腔镜肝切除术的疗效及安全性比较  

Comparison of the efficacy and safety of different hepatic inflow occlusion methods applied in laparoscopic hepatectomy

作　　者：顾炽昌 刘清波 陈坚平 马靖 区活辉 王卫东 GU Chichang;LIU Qingbo;CHEN Jianping;MA Jing;OU Huohui;WANG Weidong(Department of Hepatobiliary,Pancreatic and Spleen Surgery,Shunde Hospital of Southern Medical University/the First People's Hospital of Shunde District,Foshan City,Foshan 528308,Guangdong Province,China)

机构地区：[1]南方医科大学顺德医院/佛山市顺德区第一人民医院肝胆胰脾外科,广东省佛山市528308

出　　处：《微创医学》2024年第6期620-624,共5页Journal of Minimally Invasive Medicine

基　　金：佛山市卫生健康局医学科研课题(编号:20220330)。

摘　　要：目的观察全入肝血流阻断(Pringle法)及Glisson鞘选择性入肝血流阻断用于腹腔镜肝切除术的疗效及安全性。方法选择2022年1月至2023年12月南方医科大学顺德医院收治的腹腔镜肝切除术患者进行前瞻性研究,经倾向性评分匹配后纳入60例患者,按照随机分配方法进行分组,其中Glisson组30例、Pringle组30例。Pringle组采用全入肝血流阻断,Glisson组使用Glisson鞘选择性入肝血流阻断。比较两组手术相关指标、血清总胆红素(TBiL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、白蛋白(ALB)水平,以及术后并发症发生率。结果两组患者的肿瘤切缘、手术时间、术中出血量比较,差异均无统计学意义(均P>0.05)。与术前相比,术后两组患者的TBiL、AST、ALT水平均有所升高,ALB水平有所降低,且术后Glisson组患者的TBiL、AST、ALT水平均低于Pringle组,ALB水平高于Pringle组,差异均有统计学意义(均P<0.05)。两组患者的术后并发症发生率比较(20.00%vs.22.67%),差异无统计学意义(P>0.05)。结论与全入肝血流阻断相比,腹腔镜肝切除术中采用Glisson鞘选择性入肝血流阻断并未增加手术时间、术中出血量和术后并发症,且在肝功能保护方面具有一定优势。Objective To observe the efficacy and safety of total hepatic inflow occlusion(Pringle maneuver)and selective hepatic inflow occlusion via Glisson's pedicle in laparoscopic hepatectomy.Methods A prospective study was conducted on patients who underwent laparoscopic hepatectomy at Shunde Hospital of Southern Medical University from January 2022 to December 2023.After propensity score matching,60 patients were enrolled and randomly divided into two groups:30 patients in the Glisson group and 30 patients in the Pringle group.The Pringle group underwent total hepatic inflow occlusion,while the Glisson group received selective hepatic inflow occlusion via Glisson's pedicle.The surgical-related indicators,levels of serum total bilirubin(TBiL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and albumin(ALB),as well as the incidence of postoperative complications were compared between the two groups.Results There was no statistically significant difference in tumor resection margin,operation time and intraoperative blood loss between the two groups(all P>0.05).Compared with the preoperative levels,the levels of TBiL,AST,and ALT in both groups increased,while the ALB level decreased after the surgery.Moreover,postoperatively,the Glisson group had lower levels of TBiL,AST,and ALT and a higher ALB level than the Pringle group,and all these differences were statistically significant(all P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(20.00%vs.22.67%)(P>0.05).Conclusion Compared with total hepatic inflow occlusion,the use of selective hepatic inflow occlusion via the Glisson's pedicle in laparoscopic hepatectomy does not increase the operation time,intraoperative blood loss,or the incidence of postoperative complications,and it has certain advantages in liver function protection.

关 键 词：肝切除术 全入肝血流阻断 选择性入肝血流阻断 腹腔镜 

分 类 号：R73[医药卫生—肿瘤]