选择性半肝血流阻断联合低中心静脉压在肝切除术中的应用

Application of selective semi-hepatic vascular occlusion combined with low central venous pressure in hepatectomy

目的:探讨选择性半肝血流阻断联合低中心静脉压技术(low central venous pressure,LCVP)在肝切除术中的应用及对肝肾功能及全身血流动力学的影响.方法:2008-01/2011-01施行肝切除术的患者44例,随机分为实验组(A组,22例)和常规手术组(B组,22例).A组切肝时经药物处理使低中心静脉压(central venous pressure,CVP)维持在2-4mmHg(1mmHg=0.133kPa)、收缩压≥90mmHg,同时根据肝切除的不同部位选择行半肝血流阻断,对照组则按常规手术处理.比较两组术中出血量、心率、血压、肝肾功能、术后住院时间及术后并发症.结果:A组和B组术中出血量分别为350.2mL±175.4mL和450.3mL±135.1mL,差异有统计学意义(P<0.05);A组术后第1天,第3天ALT指标明显好于B组两组,差异有统计学意义(第1天:514.3U/L±215.6U/L vs720.2U/L±350.7U/L,P<0.05;第3天:360.1U/L±146.4U/Lvs489.1U/L±231.5U/L,P<0.05),A组术后第1天白蛋白水平与B组相比差异有统计学意义(37.5g/L±2.2g/Lvs35.4g/L±3.9g/L,P<0.05).两组术中心率(83.1次/min±11.2次/minvs75.4次/min±12.3次/min,P>0.05)、术后收缩压(131.1mmHg±18.8mmHg vs129.2mmHg±14.7mmHg,P>0.05)、肾功能(P>0.05)、住院时间(11.3d±2.4dvs12.1d±2.2d,P>0.05)及并发症率(18.2%vs22.7%,P>0.05)差异均无统计学意义.结论:在肝切除术中,选择性半肝血流阻断联合低中心静脉压技术可以有效地减少术中出血量,保护肝功能,减少缺血再灌注损伤,且对患者肾功能,术后住院时间及全身血流动力学无影响.

AIM： To investigate the application of selective semi-hepatic vascular occlusion combined with low central venous pressure （LCVP） in hepatectomy, and to analyze its effect on liver and kidney function and systemic haemodynamics. METHODS： The clinical data for 44 patients with liver diseases who underwent hepatectomy from January 2008 to January 2011 at our hospital were retrospectively analyzed. The patients were randomly divided into an experimental group （group A, n = 22） and a control group （Group B, n = 22）. When patients in Group A underwent hepatectomy, the central venous pressure （CVP） was controlled between 2-4 mm Hg （1 mmHg = 0.133 kPa） and blood pressure ≥ 90 mmHg, and selective semi-hepatic vascular occlusion was performed. Conventional surgical treatment was given to patients in group B. Intraoperative blood loss, blood pressure, heart rate, changes in liver and kidney function, postoperative hospital stay, and postoperative complications were compared between the two groups. RESULTS： Intraoperative blood loss was significantly lower in group A than in group B （350.2 mL ± 175.4 mL vs 450.3 mL ± 135.1 mL, P 〈 0.05）. Serum alanine aminotransferase （ALT） was significantly better in group A than in group B on postoperative days I and 3 （day 1：514.3 U/L ± 215.6 U/L vs 720.2 U/L ± 350.7 U/L, P 〈 0.05; day 3：360.1 U/L ± 146.4 U/L vs 489.1 U/L ± 231.5 U/L, P 〈 0.05）. Serum albumin （ALB） on postoperative day 1 was significantly higher in group A than in group B （37.5 g/L± 2.2 g/L vs 35.4 g/L ± 3.9 g/L, P 〈 0.05）. There were no statistical differences in intraoperative blood pressure （131.1 mmHg ± 18.8 mmHg vs 129.2 mmHg ± 14.7 mmHg, P 〉 0.05）, heart rate （83.1 times/ min ± 11.2 times/min vs 75.4 times/min ± 12.3 times/min, P 〉 0.05）, postoperative renal function （P 〉 0.05）, hospital stay （11.3 d ± 2.4 d vs 12.1 d ± 2.2 d, P 〉 0.05） or rate of complications （18.2% vs 22.7%, P 〉 0.05） between the two groups. CONCLUSION： During hepatectomy, selective semi-hepatic vascular occlusion combined with low central venous pressure is effective in reducing intraoperative blood loss, protecting liver function, reducing ischemia-reperfusion injury, and has no significant influence on renal function, postoperative hospital stay and systemic hemodynamics.