Pringle法及Glisson鞘选择性入肝血流阻断法在肝脏切除手术中的效果及临床意义分析

Analysis on effect and clinical significance of pringle method and glisson sheath selective hepatic inflow occlusion in liver resection

目的探讨Pringle法及Glisson鞘选择性入肝血流阻断法(SGPE)在肝脏切除手术中的效果及临床意义。方法选取2013年1月～2018年1月我院收治的腹腔镜下进行肝切除的患者82例,按照术中血流阻断方式的差异分为Pringle组(第一肝门血流阻断)和SGPE组(Glisson鞘选择性血流阻断)。研究对比两组患者术后肝脏功能、出血量、住院以及手术时间等指标的差异。结果 SGPE组住院时间、出血量以及手术时间均低于Pringle组(t=13.583,20.723,1.845;P=0.000,0.000,0.07),ALT水平均低于Pringle组(t=8.147,12.021,7.758,P=0.000,0.000,0.000);术后5d SGPE组患者前白蛋白水平高于Pringle组患者(t=10.589,14.508,9.223;P=0.000,0.000,0.000),白蛋白水平差异无统计学意义(P> 0.05)。结论在进行血流阻断时,应综合考虑到患者实际肝功能的差异,视患者实际的心血管条件进行选择,同时也要考虑到麻醉医师以及主治医师等操作习惯等因素,选择最适合患者自身的阻断方式。

Objective To explore the effect and clinical significance of Pringle method and Glisson sheath selective hepatic inflow occlusion(SGPE)in liver resection.Methods 82 patients underwent laparoscopic liver resection in our hospital from January 2013 to January 2018 were selected.According to different methods of intraoperative inflow occlusion,they were divided into the Pringle group(first porta hepatis inflow occlusion)and the SGPE group(Glisson sheath selective hepatic inflow occlusion).Postoperative liver function,bleeding volume,hospital stay and operative time of patients in the two groups were studied and compared.Results Hospital stay,bleeding volume and operative time of the SGPE group were all lower than that of Pringle group(t=13.583,20.723,1.845;P=0.000,0.000,0.07).The ALT level was lower than the Pringle group(t=8.147,12.021,7.758;P=0.000,0.000,0.000).The prealbumin level in the SGPE group was higher than that in the Pringle group(t=10.589,14.508,9.223;P=0.000,0.000,0.000),and difference in the prealbumin level was not significant(P>0.05).Conclusion In the inflow occlusion,the difference in the actual liver function of patients should be taken into account comprehensively,and the choice should be made according to the actual cardiovascular conditions of patients.At the same time,factors such as the operation habits of anesthesiologists and attending physicians should also be taken into account to select the most suitable blocking mode for patients themselves.