腹腔镜左半肝切除术中不同血流阻断方式的选择

Different choice of the blood occlusion technology in the laparoscopic left hepatectomy surgery

目的:探讨腹腔镜左半肝切除手术中不同肝脏血流阻断技术的安全性和可行性。方法:回顾性分析2014年1月至2018年1月期间,赣州市人民医院肝胆胰外科实施腹腔镜左半肝切除的67例患者的临床资料。其中35例采用改良区域性半肝阻断技术(A组),另外32例采用Pringle入肝血流阻断(B组)。结果:两组患者均未术中输血或中转开腹,两组患者的术中出血量、阻断时间、术后并发症发生率及术后住院天数差异无统计学意义(P> 0. 05),术后B组肝功能指标均高于A组(P <0. 05)。术后1月随访复查肝功能指标均正常,腹部CT未见肝脏缺血坏死或腹腔积液感染。结论:在腹腔镜左半肝切除手术中两种血流阻断方式均是安全可行的,但采用半肝血流阻断技术可以减少患者残留肝脏的缺血再灌注损伤,有利于术后肝功能恢复,减轻了胃肠道淤血水肿,同时明确了断肝线路线,减少了术中潜在肝静脉撕裂导致气体栓塞风险,对于术前肝功能不佳或合并肝硬化患者是一种更为安全可靠的手术方式。

Objectives： To explore the safety and feasibility of hemihepatic blood occlusion technology in the laparoscopic left hepatectomy surgery. Methods： The retrospective analysis was conducted on the clinical data of 67 patients who adopted different hepatic inflow occlusion methods to perform the laparoscopic left hepatectomy in our department from January, 2014 to January, 2018. Among them, 35 patients （Group A） adopted hemihepatic blood occlusion technology. Another 32cases （Group B） were treated by Pringle occlusion of hepatic blood inflow. Results： The patients in group A and group B were not performed with intraoperative blood infusion or conversion to laparotomy in the surgery. There was no significant difference between the two groups by comparing the intraoperative blood loss, clamping time, postoperative morbidity and postoperative hospital stay. Liver function indexes of group B were obviously higher than those in group A （ P 〈0.05）. Liver function indexes were normal in postoperative 1 month follow up, and abdominal CT did not see the liver ischemic necrosis or abdominal effusion and infection. Conclusion： The two hepatic vascular occlusion methods are safe and feasible in the laparoscopic left hepatectomy surgery. However, the hemihepatic blood occlusion can reduce the ischemia-reperfusion injury of the remaining liver, which would be beneficial to the postoperative liver function recovery, reduce the gastrointestinal congestion and edema, and clearly occlude the hepatic pathway. Meanwhile, the hemihepatic blood occlusion can reduce the risk of gas embolism caused by the potential hepatic vein tearing. Therefore, the hemihepatic blood occlusion technology would be a safe and reliable surgical method for patients with bad liver function or complicated liver cirrhosis.