控制性低中心静脉压在腹腔镜肝切除中的应用:前瞻性随机对照研究

Prospective Randomized Controlled Study on Controlled Low Central Venous Pressure in Laparoscopic Hepatectomy

目的探讨控制性低中心静脉压(controlled low central venous pressure,CLCVP)技术在肝细胞癌腹腔镜肝切除术中应用的有效性及安全性。方法选择2017年1~7月因肝细胞癌行腹腔镜肝切除术52例,采用密闭信封法随机分为低中心静脉压组27例(低压组,2~4 cm H2O)和正常中心静脉压组25例(对照组,5~10 cm H2O)。2组年龄、性别、肿瘤直径、肝切除范围、肝癌分期、Child-Pugh分级、总胆红素、ICG-R15、肝硬度值差异均无统计学意义(P>0.05)。比较2组手术情况、术后并发症及术后住院时间。结果小范围(≤2个肝段)肝切除时,低压组(n=13)与对照组(n=14)手术时间、术中出血量、肝门阻断时间、术后并发症发生率、术后住院时间均无统计学差异(P>0.05)。大范围肝切除时,低压组(n=14)较对照组(n=11)具有较短的手术时间[(221.4±49.9)min vs.(287.2±69.4)min,t=-2.758,P=0.011],较少的术中出血量[中位数300(60~660)ml vs.450(200~1200)ml,Z=-2.853,P=0.004],较短的肝门阻断时间[15(10~45)min vs.30(15~60)min,Z=-2.429,P=0.015]以及较短的术后住院时间[(11.9±1.7)d vs.(14.1±2.2)d,t=-0.412,P=0.010]。结论在大范围腹腔镜肝切除时应用CLCVP技术是安全有效的,能够明显减少术中出血量,减少肝门阻断时间,缩短手术时间及住院日。

Objective To investigate the efficacy and safety of controlled low central venous pressure（ CLCVP） technique in laparoscopic hepatectomy for hepatocellular carcinoma（ HCC）. Methods A prospective randomized controlled study was carried out to collect clinical data of 52 patients with hepatocellular carcinoma in our hospital from January 2017 to July 2017. By the sealed envelope method,the patients were randomized divided into either CLCVP group（ n = 27,2-4 cm H2 O） or control group（ n = 25,5-10 cm H2 O）. There were no statistically significant differences between the CLCVP group and control group in age,gender,tumor size,range of liver resection,staging of liver cancer,Child-Pugh class grade,total bilirubin,indocyanine green retention rate at 15 min（ ICG-R15）,and liver stiffness measurement（ P〉0. 05）. Intraoperative index,postoperative complications and hospitalization time were compared between the two groups. Results There were no significant differences during the small scale（ ≤2 hepatic segments） laparoscopic hepatectomy in operation time, intraoperative blood loss, blocking time of liver artery, postoperative complication rate and length of hospital stay between the CLCVP group（ n = 13） and the control group（ n = 14）. For large scale laparoscopic hepatectomy,the CLCVP group（ n = 14） had shorter operative time [（ 221. 4 ± 49. 9） min vs.（ 287. 2 ± 69. 4） min,t =-2. 758,P = 0. 011],less median intraoperative bleeding [300 ml（ 60-660 ml） vs. 450 ml（ 200-1200 ml）,Z =-2. 853,P =0. 004],shorter blocking time of liver artery [15 min（ 10-45 min） vs. 30 min（ 15-60 min）,Z =-2. 429,P = 0. 015] and shorter post hospitalization time [（ 11. 9 ± 1. 7） d vs.（ 14. 1 ± 2. 2） d,t =-0. 412,P = 0. 010]. Conclusion The application of CLCVP technology in major laparoscopic hepatectomy is safe and effective,which can significantly reduce the amount of intraoperative blood loss and the time of hepatic inflow occlusion,thus shortening the operation time and reducing the hospital stay length.