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中国癌症防治杂志 ›› 2022, Vol. 14 ›› Issue (2): 189-193.doi: 10.3969/j.issn.1674-5671.2022.02.10

• 临床研究 • 上一篇    下一篇

不同入肝血流阻断法在肝癌切除术中的应用

  

  1. 河池市第三人民医院普通外科
  • 出版日期:2022-04-25 发布日期:2022-05-11
  • 通讯作者: 覃建论 E?mail:qin.jianlun@163.com

Application of different hepatic blood flow occlusion methods in liver cancer resection

  • Online:2022-04-25 Published:2022-05-11

摘要: 目的 探讨选择性Glisson 鞘外阻断法和第一肝门阻断(Pringle)法在肝癌切除术中的价值。方法 回顾性分析2012年5月至2021年5月在河池市第三人民医院普通外科收治的93例原发性肝癌患者的临床资料,按照术中入肝血流阻断方式分组,对照组行Pringle法(n=46),观察组行选择性Glisson 鞘外阻断法(n=47),评价指标为术中出血量、手术时间以及术后白蛋白输入量、谷丙转氨酶(alanine aminotransferase,ALT)水平、总胆红素(total bilirubin,TBIL)水平、排气时间、住院时间等。结果 两组患者手术时间、术中出血量差异无统计学意义(均P>0.05)。观察组术后白蛋白输入量以及术后第1天、第3天、第5天、第7天、第10天的ALT、TBIL水平均低于对照组(均P<0.05);术后肛门排气时间较对照组短(P<0.05),住院天数也较对照组少(P<0.05)。两组患者术后并发症主要为腹腔或胸腔积液、肺部感染、肺不张,但发生率差异均无统计学意义(均P>0.05)。结论 在肝癌切除术中,选择性Glisson 鞘外阻断法出血量与Pringle法相当,但术后肝功能损害较轻,胃肠道功能恢复较快,住院时间更短且未增加术后并发症,值得进一步开展随机对照试验进行研究。

关键词: 肝癌, 肝切除术, 肝血流阻断术, 肝功能

Abstract:  Objective To investigate the value of the selective Glisson's pedicle transection method and the first portal occlusion (Pringle) method in liver cancer resection. Methods The clinical data of 93 patients with primary liver cancer in the Third People's Hospital of Hechi from May 2012 to May 2021 were retrospectively analyzed. The patients were divided into two groups according to the adopted intraoperative hepatic blood flow occlusion method. The control group received the Pringle method (n=46), and the treatment group received selective Glisson's pedicle transection method (n=47). The evaluation indexes included intraoperative blood loss, duration of operation, postoperative albumin input, alanine aminotransferase (ALT), total bilirubin (TBIL), anal exhaust time and hospital stay, and so on. Results There were no significant differences in duration of operation and blood loss between two groups (all P>0.05). The postoperative albumin input, ALT and TBIL in the treatment group were lower than those in the control group on the 1st, 3rd, 5th, 7th and 10th day after surgery (all P<0.05). The time of postoperative anal exhaust and hospitalization in the treatment group were shorter than those in the control group (all P<0.05). The main complications in two groups were abdominal or pleural effusion, lung infection and atelectasis, but there was no statistically significant in the incidence (all P>0.05). Conclusions In liver cancer resection, the selective Glisson's pedicle transection method is comparable to Pringle method, but with less postoperative liver function damage, faster gastrointestinal function recovery, shorter hospital stay and no increase in postoperative complications. Further randomized controlled trials are necessary.

Key words: Liver cancer, Hepatectomy, Hepatic blood flow occlusion, Liver function

中图分类号: 

  • R735.7