不同第一肝门血流阻断方法对肝癌肝切除术后肝功能的影响

Effect of different porta hepatis occlusion on liver function of patients after hepatectomy for liver cancer

目的探讨不同第一肝门血流阻断方法对原发性肝癌(肝癌)肝切除术后肝功能的影响。方法回顾性分析2015年1月至2017年11月空军军医大学第二附属医院行肝切除术的194例肝癌患者临床资料。其中男169例,女25例;平均年龄(52±10)岁。根据不同血流阻断方法将患者分为Pringle法阻断组(Pringle组,51例),半肝入肝血流阻断组(半肝组,96例)和选择性入肝血流阻断组(选择组,47例)。患者均签署知情同意书,符合医学伦理学规定。3组患者术前指标、围手术期情况及术后肝功能比较采用单因素方差分析和LSD-t检验。结果半肝组和选择组患者手术时间、住院时间分别为(230±20)min、(14.4±1.8)d和(220±20)min、(14.1±1.8)d,明显少于Pringle组的(256±18)min、(17.8±2.1)d(LSD-t=-27.1,-3.5和-35.9,-3.7;P<0.05)。术后第3天,选择组ALT、AST、TB分别为(327±31)U/L、(195±20)U/L、(30±3)μmol/L,明显低于Pringle组的(428±40)U/L、(320±42)U/L、(39±6)μmol/L和半肝组(386±40)U/L、(223±33)U/L、(40±6)μmol/L(LSD-t=-100.6,-124.4,-8.9和-56.4,-25.8,-9.6;P<0.05)。半肝组ALT、AST明显低于Pringle组(LSD-t=-44.2,-98.6;P<0.05)。结论与Pringle法相比,半肝入肝血流阻断和选择性入肝血流阻断的肝癌肝切除具有手术时间、住院时间较短等优势,且患者术后肝功能恢复较快,尤以选择性入肝血流阻断优势更为明显。

Objective To compare the effect of different porta hepatis occlusion on the liver function of patients after hepatectomy for primary liver cancer (PLC). Methods Clinical data of 194 patients with PLC who underwent hepatectomy in the Second Affiliated Hospital of Air Force Medical University from January 2015 to November 2017 were retrospectively analyzed. Among them, 169 patients were male and 25 were female, aged (52±10) years. According to the different occlusion used, all patients were divided into Pringle maneuver group (Pringle group, n=51), hemi-hepatic vascular occlusion group (hemi-hepatic group, n=96) and selective hepatic vascular occlusion group (selective group, n=47). The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperative indexes, perioperative conditions and postoperative liver function were compared among three groups by one-way ANOVA and LSD-t test. Results The operation time and length of hospital stay in hemi-hepatic and selective groups were (230±20) min,(14.4±1.8) d and (220±20) min,(14.1±1.8) d respectively, significantly shorter than (256±18) min and (17.8±2.1) d in Pringle group (LSD-t=-27.1,-3.5 and -35.9,-3.7;P<0.05). At postoperative 3 d, ALT, AST and TB in selective group were (327±31) U/L,(195±20) U/L and (30±3)μmol/L, significantly lower compared with (428±40) U/L,(320±42) U/L and (39±6)μmol/L in Pringle group and (386±40) U/L,(223±33) U/L and (40±6)μmol/L in hemi-hepatic group (LSD-t=-100.6,-124.4,-8.9 and -56.4,-25.8,-9.6;P<0.05). ALT and AST in hemi-hepatic group were significantly lower than those in Pringle group (LSD-t=-44.2,-98.6;P<0.05). Conclusions Compared with Pringle maneuver, hepatectomy for liver cancer with hemi-hepatic or selective hepatic vascular occlusion has the advantages of shorter operation time and length of hospital stay, and faster recovery of liver function after surgery, especially the selective hepatic vascular occlusion.