门静脉压监测对肝癌合并肝硬化患者术后腹水治疗的影响

Study on portal vein pressure monitoring in the treatment of postoperative ascites in patients with liver cancer and cirrhosis

目的研究门静脉压力对肝癌合并肝硬化患者术后腹水的影响。方法回顾性分析2015年1月至2019年12月该院收治的90例肝癌合并肝硬化患者的临床资料,根据肝组织病理报告及术中测得门静脉压值将患者分为肝癌无门静脉高压组(A组)及肝癌合并门静脉高压组(B组),监测并比较A、B两组肝癌切除前、后门静脉压的差别。收集A、B两组患者术中及术后相关参数[肝功、凝血酶原时间(PT)、术后每天腹水引流量、引流管拔除时间、术后住院时间等]并进行比较。结果A组肝癌切除时间、肝门阻断时间、术中出血量及输血量,明显少于B组,差异有统计学意义(P<0.05)。术后A组平均每天腹水引流量、平均引流管拔除时间及术后住院时间显著低于B组,差异有统计学意义(均P<0.05)。术后第3天A组丙氨酸氨基转移酶(ALT)、清蛋白(ALB)、总胆红素(TBIL)、PT、腹水引流量均优于B组。术后第7天A、B两组ALB、腹水引流量比较,差异无统计学意义(P>0.05)。结论门静脉压对肝癌合并肝硬化患者术后腹水的治疗有影响。

Objective To study the effect of portal vein pressure on postoperative ascites in patients with liver cancer and cirrhosis.Methods The clinical data of 90 patients with liver cancer and cirrhosis admitted to this hospital from January 2015 to December 2019 were retrospectively analyzed.Based on the liver histopathological report and intraoperative portal vein pressure,they were divided into liver cancer without portal hypertension group(group A)and liver cancer combined with portal hypertension group(group B),the difference in portal vein pressure between group A and group B before and after liver cancer resection were monitored and compared.The relevant parameters[liver function,prothrombin time(PT),postoperative daily ascites drainage,extubation time,postoperative hospital stay]before and after liver cancer resection were collected and compared between group A and group B.Results The resection time of liver cancer,hepatic portal block time,the volume intraoperative blood loss and blood transfusion in group A were significantly shorter or less than those of group B,and the differences were statistically significant(P<0.05).The average daily ascites drainage,average extubation time and hospitalization time after operation in group A were significantly lower than those in group B,the difference were statistically significant(P<0.05).On the third day after operation,alanine aminotransferase(ALT),albumin(ALB),total bilirubin(TBIL),and PT in group A were better than those in group B.There were statistically significant differences in ALB and ascites drainage between group A and group B on the 7 th day after surgery(P>0.05).Conclusion Portal vein pressure is great significance in the treatment of postoperative ascites in patients with liver cancer and cirrhosis.