不阻断入肝血流采用BiClamp~钳在肝硬化肝癌切除术中的应用

The application of BiClamp~ in liver resection for liver cirrhosis liver caner without hepatic blood inflow occlusion

目的探讨不阻断入肝血流采用BiClamp~钳在肝硬化肝癌患者肝切除术术中的安全性和有效性。方法回顾性分析2014年6月至2017年9月接受肝切除术的72例合并肝硬化的原发性肝癌患者的临床资料,根据术中是否行第一肝门阻断分为两组:不阻断入肝血流组36例,阻断入肝血流组36例,所有病例均由同一手术组完成,离断肝实质器械均为BiClamp~钳。比较两组患者手术时间、肝断面面积、断肝时间、断肝速度、术中出血量、肝断面单位面积出血量、术中输血率、术后并发症发生率、住院时间以及术后第1天、第3天及第7天白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及总胆红素(TB)等水平的差异。结果不阻断入肝血流组和阻断入肝血流组手术时间(182.5±66.81min vs 188.47±66.97min;p=0.707)、断肝时间(32.70±25.40 min vs 27.58±18.16 min;P=0.215)、术中出血量(369.26±295.97 ml vs346.00±248.63 ml;P=0.613)及术后并发症发生率(22.2%vs 33.3%;P=0.293)差异均无统计学意义。不阻断入肝血流组术后第3天血清ALT(142.36±84.29 u/L vs 252.50±207.07 u/L;P=0.027)、AST(94.78±65.10 u/L vs 139.22±107.69u/L;P=0.002)水平及术后第7天血清ALT(74.58±51.06 u/L vs 100.31±77.71 u/L;P=0.034)、AST(38.42±17.32 u/L vs55.28±36.28 u/L;P=0.001)水平低于阻断入肝血流组,两组差异有统计学意义(P<0.05)。结论对于肝硬化肝癌患者,不阻断入肝血流情况下采用BiClamp~钳切肝是安全有效的,同时不增加术中出血量。

Objective To evaluate the efficacy and safety of BiClamp in liver resection for liver cirrhosis liver caner without hepatic blood inflow occlusion. Methods The clinical data of 72 patients with liver cirrhosis and malignant 1 iver tumor undergoing liver resection from June 2014 to September 2017 were retrospectively analyzed. The patients were divided into two groups ：without he- patic blood flow occlusion group （ n = 36） and hepatic blood flow occlusion group （ n = 36）. All patients operated by the same surgical group. All bepatectomies were performed using BiClamp. The operative time, liver cut surface area, liver transaction time, transaction speed, intraoperative blood loss, blood loss per transection area, the rate of blood transfusion, the rate of postoperative complications, the postoperative hospital stay, and levels of ALB, AST, ALT and TB on the postoperative day（POD） 1,3and 7 in two groups were com- pared. Results There were no significant differences in the operative time（ 182. 5 ± 66. 81 min vs 188. 47± 66. 97min;P = 0. 707）, liver transaction time （32.70 ± 25.40 min vs 27.58 ± 18.16 min; P = 0.215 ） ,intraoperative blood loss （369.26 ± 295.97 ml vs 346.00 ± 248.63 ml ;P = 0. 613 ）, and operative morbidity （22.2% vs 33.3%;P = 0. 293 ）. The without hepatic blood flow occlusion group showed 1 evels of ALT（ 142. 36 ± 84. 29 u/L vs 252. 50 ± 207. 07 u/L ;P = 0. 027） and AST（94.78 ± 65.10 u/L vs 139. 22 ± 107. 69 u/L;P =0. 002） on the POD 3 and levels of ALT（74. 58 ±51.06 u/L vs 100. 31 ±77.71 u/L;P =0. 034） and AST（38.42 ± 17.32 u/L vs 55.28 ± 36. 28u/L ;P = 0. 001 ） on the POD 7 lower than in the hepatic blood flow occlusion group. Conclusion For the pa- tients with liver cirrhosis undergoing liver resection without hepatic blood inflow occlusion, use of BiClamp~ would reduce the damage to the liver function and not increase the intraoperative blood loss.