不同肝血流阻断技术在肝囊型包虫病外囊剥除术中的应用比较

Comparison of different hepatic blood occlusion methods in external capsule excision for hepatic cystic echinococcosis

目的:比较不同肝血流阻断技术在肝囊型包虫病外囊剥除术中的应用效果。方法:选取56例行外囊剥除术的肝囊型包虫病患者,其中31例采用Glisson蒂血流阻断法阻断入肝血流(Glisson蒂阻断组),25例采用Pringle法阻断入肝血流(Pringle组),比较两组患者的相关临床指标。结果:两组患者术前一般资料具有可比性。两组手术时间、阻断时间、术中出血量、术后引流量、住院费用差异均无统计学意义(均P>0.05),Glisson蒂阻断组术后排气时间、术后住院时间短于Pringle组(均P<0.05);肝功能指标方面,Glisson蒂阻断组术后谷丙转氨酶、谷草转氨酶明显低于Pringle组(均P<0.05),两组术后总胆红素水平无统计学差异(P>0.05);凝血酶原时间以及应激反应指标C反应蛋白、HOMA-IR指数、肿瘤坏死因子α两组间差异均无统计学意义(均P>0.05)。两组术后均无并发症发生。结论:与Pringle法比较,Glisson蒂阻断法有利于肝囊型包虫病外囊剥除术后患者肝功能的恢复。

Objective： To compare the clinical effects of different hepatic blood occlusion procedures in external capsule excision for hepatic cystic echinococcosis. Methods： Fifty-six patients with hepatic cystic echinococcosis undergoing external capsule excision were enrolled. Of the patients, 31 cases underwent hepatic blood inflow occlusion by Glisson’s pedicle ligation （Glisson’s pedicle occlusion group）, and 25 cases underwent hepatic blood inflow occlusion by Pringle’s procedure （Pringle group）. The main clinical variables between the two groups of patients were compared. Results： The preoperative data were comparable between the two groups of patients. There were no significant differences in operative time, occlusion time, intraoperative blood loss, amount of postoperative drainage and hospitalization cost between the two groups of patients （all P〉0.05）, but the time to postoperative anal gas passage and length of postoperative hospital stay in Glisson’s pedicle occlusion group were significantly shorter than those in Pringle group （both P〈0.05）. As for the liver function parameters, the postoperative alanine transaminase and aspartate transaminase levels in Glisson’s pedicle occlusion group were significantly lower than those in Pringle group （both P〈0.05）, but no significant difference were noted in postoperative total bilirubin levels between the two groups （P〉0.05）. There were no significant differences in prothrombin time and stress response indicators such as C-reactive protein, HOMA-IR index and tumor necrosis factor α between the two groups （all P〉0.05）. Conclusion： Hepatic blood inflow occlusion by method of Glisson’s pedicle ligation can promote the postoperative liver function recovery in patients with hepatic cystic echinococcosis undergoing external capsule excision compared with that by Pringle’s procedure.