肝下下腔静脉阻断技术在机器人辅助腹腔镜肝切除术中的应用效果

Evaluation of infrahepatic inferior vena cava clamping in robot-assisted laparoscopic liver resection

目的探讨肝下下腔静脉阻断技术在机器人肝切除术中的可行性和有效性。方法回顾性分析2015年2月至2017年12月华中科技大学同济医学院附属同济医院肝脏外科中心采用机器人行肝切除术治疗的24例患者资料,根据术中控制低中心静脉压的方式不同分为肝下下腔静脉阻断组(8例)和低中心静脉压组(16例)。肝下下腔静脉阻断组男性6例,女性2例,年龄49岁(范围:20~56岁);低中心静脉压组男性15例,女性1例,年龄53岁(范围:38~69岁)。通过t检验、非参数检验、χ²检验或Fisher确切概率法比较两组患者的术中出血量、肝门阻断时间、输血量、术中血流动力学变化及术后并发症、肝肾功能变化等。结果肝下下腔静脉阻断组的术中出血量[M(QR)]为200(220)ml(范围:100~400 ml),低于低中心静脉压组的750(800)ml(范围:100~2000 ml)(Z=-2.169,P=0.030)。肝下下腔静脉阻断组第一肝门阻断时间为24(18)min,肝下下腔静脉阻断时间为29(20)min,低中心静脉压组第一肝门阻断时间为23(23)min,两组第一肝门阻断时间的差异无统计学意义(Z=-0.323,P=0.747)。肝下下腔静脉阻断组无术中输血病例,低中心静脉压组术中输血5例,输血量1.5(1.5)U,两组输血量的差异有统计学意义(Z=-3.353,P=0.001)。术中阻断肝下下腔静脉后,患者平均动脉压由(88.6±4.9)mmHg(1 mmHg=0.133 kPa)降至(67.4±3.8)mmHg,低于低中心静脉压组的(72.4±3.3)mmHg(t=2.315,P=0.003)。两组患者的术后并发症及肝肾功能变化的差异均无统计学意义(P值均>0.05)。结论在机器人辅助腹腔镜肝切除术中,可通过肝下下腔静脉阻断技术控制患者的中心静脉压,操作简单,对患者的肝肾功能无明显影响。

Objective To evalutate the safety and efficacy of infrahepatic inferior vena cava clamping robot-assisted laparoscopic liver resection.Methods All data about 24 patients with robotic liver resection at Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between February 2015 and December 2017 were collected and analyzed.These patients were divided into two groups based on different methods to decrease central venous pressure.Eight patients(6 males and 2 females,aged 49 years(range:50 to 56 years))were applied with infrahepatic inferior vena cava clamping,and the other 16 matched cases(15 males and 1 female,aged 53 years(range:38 to 69 years))were categorized into lowering central venous pressure group.Intraoperative blood loss,blood transfusion,intraoperative hemodynamic parameters,postoperative complications,and renal function were compared by t-test,non-parametric test,χ^(2)test,or Fisher exact test.Results There was significantly difference in the intraoperative blood loss between the infrahepatic vena cava clamping group and the lowering central venous group(200(220)ml(range:100 to 400 ml)vs.750(800)ml(range:100 to 2000 ml),Z=‒2.169,P=0.030).The clamping time of portal triad and infrahepatic inferior vena cava were 24(18)minutes and 29(20)minutes in the infrahepatic inferior vena cava clamping group,and portal triad clamping time was 23(23)minutes in the low central venous group.There was no significant difference between the two groups(Z=‒0.323,P=0.747).There was no intraoperative blood transfusion in the infrahepatic inferior vena cava clamping group,and 5 cases in the low central venous group,with a transfusion volume of 1.5(1.5)U.The difference between the two groups was statistically significant(Z=‒3.353,P=0.001).However,the mean arterial pressure in the infrahepatic vena cava clamping group decreased from(88.6±4.9)mmHg to(67.4±3.8)mmHg(1 mmHg=0.133 kPa),which was lower than that of lowering central venous group(72.4±3.3)mmHg(t=2.315,P=0.003).And there were no significant differences related to postoperative complications rate or hepatic and renal function in both groups.Conclusion The infrahepatic inferior vena cava technology is safe and feasible to decrease central venous pressure during robotic liver resections,which will not affect the recovery of hepatic and renal functions.