间歇性全入肝血流阻断与区域性入肝血流阻断腹腔镜肝切除术治疗原发性肝癌患者术后恢复研究*

doi:10.3969/j.issn.1672-5069.2022.03.027

摘要/Abstract

摘要： 目的探讨采取间歇性全入肝血流阻断与区域性入肝血流阻断腹腔镜肝切除术(LH)治疗原发性肝癌(PLC)患者术后恢复情况。方法 2016年3月～2021年3月我院诊治的128例PLC患者,均接受LH手术治疗,其中57例在术中采取间歇性全入肝血流阻断法,另71例采取区域性入肝血流阻断法。监测平均动脉压(MAP)和心率(HR),使用多普勒超声检测门静脉血流速度(PVV)。结果区域血流阻断组术中出血量和肝血流阻断时间分别为(305.4±58.6)mL和(0.0±0.0)min,显著少于或短于全肝血流阻断组【分别为(382.5±60.3)mL和(24.2±7.5)min,P＜0.05】;在术后7 d,区域血流阻断组血清总胆红素水平为(16.4±8.5)μmol/L,血清白蛋白水平为(35.6±5.3)g/L,与全肝血流阻断组【分别为(25.7±7.2)μmol/L和(32.4±4.9)g/L】比,差异显著(P＜0.05);区域血流阻断组MAP、HR和PVV分别为(85.6±2.3)mmHg、(78.7±8.3)次/min和(20.3±0.2)cm/s,与全肝血流阻断组【分别为(86.8±2.5)mmHg、(79.6±8.1)次/min和(20.1±0.3)cm/s】比,差异无统计学意义(P＞0.05);术后,区域血流阻断组腹腔内出血、胆汁漏、胸腔积液和肺部感染发生率分别为1.4%、8.5%、14.1%和5.6%,与全肝血流阻断组(分别为3.5%、10.5%、22.8%和10.5%)比,差异无统计学意义(P＞0.05)。结论采取区域性入肝血流阻断LH治疗PLC患者有较好的手术和术后恢复效果,能够有效降低术中出血量,减少肝血流阻断时间,减轻术后肝功能损伤。

关键词: 原发性肝癌, 腹腔镜肝切除术, 区域性入肝血流阻断, 间歇性全入肝血流阻断, 手术

Abstract: Objective The aim of this study was to compare the strategy of intermittent total hepatic inflow occlusion (ITHIO) and regional hepatic inflow occlusion (RHIO) during laparoscopic hepatectomy (LH) in patients with primary liver cancer (PLC). Methods 128 patients with PLC were recruited in our hospital between March 2016 and March 2021, and all patients underwent LH. During the operation, the ITHIO was applied in 57 cases and RHIO was carried out in 71 cases. The mean arterial pressure (MAP), heart rate (HR), and portal vein velocity (PVV) were obtained. Results The intraoperative blood loss and hepatic blood occlusion time in patients with RHIO were (305.4±58.6)mL and (0.0±0.0)min, significantly less or shorter than [(382.5±60.3)mL and (24.2±7.5)min, respectively, P＜0.05] in patients with ITHIO; seven days after operation, serum bilirubin level was (16.4±8.5)μmol/L and serum albumin level was (35.6±5.3)g/L in patients with RHIO, significantly different compared to [(25.7±7.2)μmol/L and (32.4±4.9)g/L, respectively, P＜0.05] in patients with ITHIO; the MAP, HR and PVV in patients with RHIO were (85.6±2.3)mmHg, (78.7±8.3)beats/min and (20.3±0.2)cm/s, not significantly different compared to [(86.8±2.5)mmHg,(79.6±8.1)beats/min and (20.1±0.3)cm/s, P＞0.05] in patients with ITHIO; after operation, the incidences of intraabdominal bleeding, bile leakage, pleural effusion and pulmonary infections in patients with RHIO were 1.4%, 8.5%, 14.1% and 5.6%, not significantly different compared to 3.5%, 10.5%, 22.8% and 10.5% in patients with ITHIO (P＞0.05). Conclusion The strategy of RHIO during LH in dealing with patients with PLC is good with less intraoperative blood loss, shortened hepatic blood occlusion time and alleviation of postoperative liver function recovery.

Key words: Hepatoma, Laparoscopic hepatectomy, Regional hepatic inflow occlusion, Intermittent total hepatic inflow occlusion, Surgery

胡勇军, 汪磊, 刘宁, 晏华军. 间歇性全入肝血流阻断与区域性入肝血流阻断腹腔镜肝切除术治疗原发性肝癌患者术后恢复研究^*[J]. 实用肝脏病杂志, 2022, 25(3): 411-414.

Hu Yongjun, Wang Lei, Liu Ning, et al. Strategy of intermittent total hepatic inflow occlusion and regional hepatic inflow occlusion during laparoscopic hepatectomy in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2022, 25(3): 411-414.

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间歇性全入肝血流阻断与区域性入肝血流阻断腹腔镜肝切除术治疗原发性肝癌患者术后恢复研究^*

Strategy of intermittent total hepatic inflow occlusion and regional hepatic inflow occlusion during laparoscopic hepatectomy in patients with primary liver cancer

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