区域性入肝血流阻断腹腔镜精准肝切除术治疗原发性肝癌患者价值评估*

doi:10.3969/j.issn.1672-5069.2026.03.024

摘要/Abstract

摘要： 目的探讨区域性入肝血流阻断行腹腔镜精准肝切除术(LPLR)治疗原发性肝癌(PLC)患者的应用价值。方法 2022年10月～2024年10月我院收治的PLC患者83例,均接受LPLR手术治疗,其中42例观察组患者采用区域性入肝血流阻断,另41例对照组患者采用常规间歇性全入肝血流阻断。使用流式细胞仪检测外周血淋巴细胞亚群,采用硫代巴比妥酸法检测血清丙二醛(MDA),采用黄嘌呤氧化酶法检测血清超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)。结果观察组术中出血量和手术时间显著多于或长于对照组(P＜0.05);在术后3 d,观察组血清TBIL、AST和INR分别为(20.7±3.2)μmol/L、(38.6±5.1)U/L和(1.1±0.1),均显著低于对照组【分别为(25.7±4.9)μmol/L、(49.8±5.2)U/L和(1.2±0.2),P＜0.05】;观察组外周血CD4⁺细胞百分比和CD4⁺／CD8⁺细胞比值分别为(62.2±4.9)%和(2.2±1.2),均显著大于对照组【分别为(55.3±4.5)%和(1.6±0.2),P＜0.05】;观察组血清MDA水平为(3.4±0.9)mmol/mL,显著低于对照组【(4.2±1.1)mmol/mL,P＜0.05】,而血清SOD和GSH-Px水平分别为(108.5±18.7)U/mL和(69.0±7.8)U/L,均显著高于对照组【分别为(92.2±18.0)U/mL和(61.2±7.2)U/L,P＜0.05】;术后,观察组并发症发生率为28.6%,显著低于对照组的65.9%(P＜0.05)。结论采取区域性入肝血流阻断能有效减轻LPLR术对患者肝功能、氧化应激和淋巴细胞功能的不良影响,或可减少并发症的发生。

关键词: 原发性肝癌, 腹腔镜精准肝切除术, 区域性入肝血流阻断, 肝损伤, 治疗

Abstract: Objective This study aimed to investigate regional hepatic inflow occlusion (RHIO) for laparoscopic precision liver resection (LPLR) in treatment of patients with primary liver cancer (PLC). Methods 83 patients with PLC were encountered in our hospital between October 2022 and October 2024, all underwent LPLR and for RHIO, they were randomly assigned to either the observation group (n=42) for RHIO, or the control group (n=41) with conventional Pringle maneuver, e.g., intermittent total hepatic inflow occlusion (ITHIO). Serum malondialdehyde (MDA) level was detected by thiobarbituric acid method, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity were measured by xanthine oxidase method. Peripheral blood lymphocyte subsets was determined by FCM. Results Intraoperative blood loss and operation time in the observation group were much greater or longer than in the control group(P＜0.05); by 3 days after operation, serum bilirubin, AST and INR in the observation group were (20.7±3.2)μmol/L, (38.6±5.1)U/L and (1.1±0.1), all much lower than [(25.7±4.9)μmol/L, (49.8±5.2)U/L and (1.2±0.2), respectively, P＜0.05] in the control; percentage of peripheral blood CD4⁺ cells and CD4⁺／CD8⁺ cell ratio were (62.2±4.9)% and (2.2±1.2), both significantly greater than [(55.3±4.5)% and (1.6±0.2), respectively, P＜0.05] in the control; serum MDA level was (3.4±0.9)mmol/mL, much lower than [(4.2±1.1)mmol/mL, P＜0.05], while serum SOD and GSH-Px levels were(108.5±18.7)U/mL and(69.0±7.8)U/L,both much higher than [(92.2±18.0)U/mL and (61.2±7.2)U/L, respectively, P＜0.05] in the control; post-operationally, incidence of complications in the observation was 28.6%, much lower than 65.9%(P＜0.05) in the control group. Conclusion LPLR under support of RHIO for patients with PLC is superior to under ITHIO, which might lead to mild liver injury and accelerate postoperative recovery.

Key words: Hepatoma, Laparoscopic precision liver resection, Regional hepatic inflow occlusion, Liver injury, Therapy

杜隆, 孙世杰, 尹子文. 区域性入肝血流阻断腹腔镜精准肝切除术治疗原发性肝癌患者价值评估^*[J]. 实用肝脏病杂志, 2026, 29(3): 413-416.

Du Long, Sun Shijie, Yin Ziwen. Laparoscopic precision liver resection by regional hepatic inflow occlusion in the treatment of patients with primary liver cancer[J]. Journal of Practical Hepatology, 2026, 29(3): 413-416.

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区域性入肝血流阻断腹腔镜精准肝切除术治疗原发性肝癌患者价值评估^*

Laparoscopic precision liver resection by regional hepatic inflow occlusion in the treatment of patients with primary liver cancer

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