交替性区域入肝血流阻断在肝癌合并肝硬化患者肝切除术中的临床效果

Clinical effect of alternate regional inflow into the liver for hepatectomy in patients with hepatocellular carcinoma and cirrhosis

目的研究交替性区域入肝血流阻断在肝癌合并肝硬化患者肝切除术中的安全性,并评价临床应用效果。方法本研究为回顾性病例对照研究。选取2016年9月至2020年4月广元市中医医院收治的56例行肝切除术的肝癌合并肝硬化患者,根据入肝血流阻断方式的不同分为两组,其中交替阻断组(26例)采用交替性区域入肝血流阻断技术,传统阻断组(30例)采用区域血流阻断技术。分别统计两组患者围手术期指标,术前及术后第1、3、7天时的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、白三烯C4(LTC4)等指标变化情况,术后并发症发生情况。结果交替阻断组术中出血量显著少于传统阻断组,差异有统计学意义(P<0.05),其余围手术期指标比较差异均无统计学意义。两组患者术前ALT、AST、IL-6、TNF-α和LTC4水平差异均无统计学意义,术后水平均先升高随后逐渐减低,传统阻断组术后第1、3、7天时ALT、AST、IL-6、TNF-α和LTC4水平均高于同期交替阻断组,差异有统计学意义(P<0.05)。交替阻断组术后总并发症发生率低于传统阻断组,差异有统计学意义(P<0.05)。结论相比于Pringle法,肝癌合并肝硬化患者肝切除术中行交替性区域入肝血流阻断,能够减少术中出血及术后输血,减轻肝损伤,降低再灌注应激反应及并发症发生率,安全可行,更有利于患者术后恢复。

Objective To investigate the safety and clinical efficacy of alternate region entry blood flow occlusion in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis.Methods This was a retrospective case-control study.From September 2016 to April 2020,56 cases of liver cancer with liver cirrhosis from Guangyuan Traditional Chinese Medicine Hospital were selected.According to the different ways of blood flow blocking into the liver,they were divided into the alternatingblock group(26 cases)and the traditional-block group(30 cases).The perioperative indicators of the two groups were counted respectively,including changes of alanine aminotransferase(ALT),aspartate aminotransferase(AST),interleukin-6(IL-6),tumor necrosis factorα(TNF-α),leutriene C4(LTC4)before and after operation on day 1,3 and 7.The occurrence of postoperative complications were compared between the two groups.Results The intraoperative blood loss in the alternating-block group was significantly lower than that in the conventional block group,and the difference was statistically significant(P<0.05),while the other perioperative indicators showed no statistical significance.There were no statistically significant differences in ALT,AST,IL-6,TNF-αand LTC4 levels between the two groups before surgery,and the levels in the traditional-block group were all higher than those in the alternatingblock group after the operation,with statistically significant differences(P<0.05).The incidence of postoperative complications in the alternating-block group was lower than that in the traditional-block group(P<0.05).Conclusion Compared with Pringle method,alternate regional blood flow blocking in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis can reduce intraoperative bleeding,alleviate liver injury,depress reperfusion stress reaction and incidence of complications,which is safe and feasible,and more conducive to postoperative recovery of patients.