不同肝血流阻断方式对肝切除术安全性及预后的影响

Effect of different hepatic blood occlusion methods on the safety and grognosis of patients undergoing hepatectomy

目的分析不同肝血流阻断方式对肝切除术患者围术期指标、肝功能及3年无瘤生存期的影响。方法选取自2012年1月~2014年12月于我院行肝切除并采用Pringle法联合肝下腔静脉阻断肝血流的60例患者作为观察组,另按随机、平衡、对照原则选取同期于我院行肝切除术但仅采用Pringle法肝血流的60例患者作为对照组。对比两组围术期指标(手术时间、断肝时间、第一肝门阻断时间、术中出血量、术中输血例数、术中液体总入量及术后并发症)、肝功能[总胆红素(TB)、谷丙转氨酶(ALT)、前白蛋白(Pre-ALB)]及1年、3年无瘤生存率。结果 (1)观察组手术时间、断肝时间、第一肝门阻断时间均较对照组短;术中出血量、术中输血例数、术中液体总入量及术后并发症发生率均较对照组少,但仅术中出血量、术中输血比例、术后并发症发生率对比差异有统计学意义(P<0.05);(2)两组术后1d时TB、ALT显著上升,并以术后3d为峰值,术后7d可见显著下降;Pre-ALB术后呈持续下降趋势,与同组术前比较,各指标差异均有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);(3)经随访统计,观察组1年及3年无瘤生存率显著高于对照组,对比差异有统计学意义(P<0.05)。结论 Pringle法联合肝下腔静脉阻断肝血流时,肝切除术患者术中出血量、输血比例、并发症及3年无瘤生存率等指标获益更显著,且对肝功能的影响与单一Pringle法肝血流阻断方式无显著差异。

Objective To analyze the effect of different hepatic blood occlusion methods on perioperative indexes, liver func- tion and 3-year tumor-free survival of patients undergoing hepatectomy. Methods 60 patients who underwent hepatectomy, Pringle method and infrahepatic inferior vena cava occlusion in the hospital from January 2012 to December 2014 were selected as the observa- tion group. Another 60 patients who underwent hepatectomy and hepatic blood occlusion Pringle method in the hospital at the same time were selected as the control group. The perioperative indicators （operation time, hepatic blood occlusion time, the first hepatic portal occlusion time, intraoperative blood loss, cases undergoing intraoperative blood transfusion, total intraoperative infused liquid volume and postoperative complications）, liver function [ total bilirubin （TB）, alanine aminotransferase （ALT）, prealbumin （Pre-ALB）], 1-year and 3-year tumor -free survival were compared between the two groups. Results （~）The operation time, hepatic blood occlusion time and the first hepatic portal occlusion time of the observation group was shorter than that of the control group. The intraoperative blood loss, cases undergoing intraoperative blood transfusion, total intraoperative infused fluid volume and incidence of postoperative complication were less / lower than those in the control group. However, there only were statistically significant differences in intraop- erative blood loss, ratio of intraoperative blood transfusion and incidence of postoperative complications （ P 〈 0. 05 ）. （2）The TB and ALT in the two groups were increased significantly at ld after operation. They were the highest at 3d after operation, and were signifi- cantly decreased at 7d after operation. The Pre-ALB showed a continuously decreasing trend after operation. Compared with that in the same group before operation, there were statistically significant differences （ P 〈 0. 05 ）, but there was no significant difference between groups （ P 〉 0. 05 ）. （1）The follow-up results showed that the l-year and 3-year tumor -free survival rates of the observation group were significantly higher than those of the control group （ P 〈 0. 05）. Conclusion The Pringle method combined with hepatic inferior vena cava occlusion of hepatic blood flow can obviously decrease the intraoperative blood, blood transfusion and complications, and improve the 3-year tumor-free survival of patients undergoing hepatectomy, without effect on the liver function. Compared with Pringle method alone, there is no significant difference.