腹腔镜肝切除术中应用低中心静脉压与肝血流阻断的回顾分析研究

A retrospective analysis of laparoscopic hepatectomy with low central venous pressure and hepatic blood flow occlusion

目的:探讨腹腔镜肝切除术中应用低中心静脉压及肝血流阻断技术对手术、预后的影响。方法:选取2017年1月至2019年6月84例行腹腔镜肝切除术的患者,45例应用控制性低中心静脉压技术(LCVP),39例纳入未控制的普通中心静脉压(NCVP)组。比较手术切除肝实质组织所需时间、术中失血量、是否输血、术后肝功能、住院时间等。结果:LCVP组术中出血量、肝切除时间、肝门阻断时间低于NCVP组,差异有统计学意义(P<0.05);两组术后并发症、住院时间差异无统计学意义(P>0.05);LCVP组术后第5天AST恢复情况优于NCVP组,其余生化指标差异无统计学意义(P>0.05)。结论:腹腔镜肝切除术中间歇肝门血流阻断后应用LCVP安全、有效,可进一步减少术中出血量,缩短手术时间,术后患者肝功能恢复水平不劣于仅肝门血流阻断后未控制中心静脉压的患者。

Objective:To investigate the intraoperative and prognostic effects of low central venous pressure(LCVP)and hepatic blood flow occlusion in laparoscopic hepatectomy.Methods:Clinical data of 84 patients who underwent laparoscopic hepatectomy from Jan.2017 to Jun.2019 were retrospectively analyzed.45 cases were treated with controlled LCVP and 39 cases were treated with uncontrolled normal central venous pressure(NCVP).The time required for surgical resection of liver parenchyma,intraoperative blood loss,blood transfusion,postoperative liver function and hospital stay were compared.Results:The median intraoperative blood loss,mean hepatectomy time and hepatic blood flow occlusion time in LCVP group were less than those in NCVP group(P<0.05).There was no significant difference in the postoperative complications and postoperative hospital stay between the two groups(P>0.05).The recovery level of AST in LCVP group was better than that in NCVP group at the fifth day after surgery,and there was no statistical difference in other biochemical indexes(P>0.05).Conclusions:The application of LCVP technique after hepatic blood flow intermittent occlusion can further reduce intraoperative blood loss and shorten operation time,and this technique is safe and effective.The postoperative recovery level of liver function is effectual in LCVP technique.