腹腔镜肝切除术下展开肝主流阻断技术治疗原发性肝癌的疗效观察

Clinical observation of liver mainstream occlusion in the treatment of primary liver cancer under laparoscopic hepatectomy

目的研究腹腔镜肝切除术下展开肝主流阻断技术治疗原发性肝癌的疗效。方法回顾性选择2018年9月至2020年2月于新疆医科大学第一附属医院行腹腔镜肝切除术且未中转开腹患者162例,其中采用全入肝血流阻断技术52例为A组,半肝血流阻断技术54例为B组,半肝血流阻断加肝静脉控制技术56例为C组。比较3组疗效指标[术后通气时间,引流管留置时间,肝功能指标丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转氨酶(AST)、总胆红素(TBIL)水平,治愈率]和安全性指标(手术指标:手术时间、术中出血量、输血率,术后并发症发生率、病死率)。结果C组术中出血量[(148.77±31.33)mL]、术中输血率(3.57%)低于A、B组[(198.02±40.14)mL、9.26%;(229.63±48.36)mL、11.54%],差异有统计学意义(P<0.05)。B组术中出血量和术中输血率均低于A组,差异有统计学意义(P<0.05)。术后3 d,B、C组ALT、AST、TBIL水平[(90.35±38.87)U/L、(85.56±20.11)U/L、(22.12±3.96)μmol/L;(88.98±35.46)U/L、(87.74±20.13)U/L、(21.37±4.01)μmol/L]均低于A组[(201.03±58.62)U/L、(129.99±34.58)U/L、(36.63±4.57)μmol/L],差异均有统计学意义(P<0.05)。B、C组术后通气时间、引流管留置时间、术后住院时间[(22.41±3.54)h、(9.03±1.06)d、(10.11±2.06)d;(20.55±3.48)h、(8.77±0.98)d、(10.02±2.03)d]低于A组[(30.22±4.65)h、(9.96±1.22)d、(11.54±2.30)d],差异均有统计学意义(P<0.05),而治愈率(81.48%、87.50%)高于A组(57.69%),差异有统计学意义(P<0.05)。3组病死率分别为1.92%、0、0,差异无统计学意义(P>0.05)。C组术后总并发症发生率(3.57%)低于A组(26.92%),差异有统计学意义(P<0.05)。结论半肝血流阻断加肝静脉控制法可有效保护残肝肝功能,有效控制术中出血,提高了患者术后恢复、治愈率,减少了术后并发症发生。

Objective To investigate the efficacy of hepatic vascular exclusion in laparoscopic hepatectomy for primary liver cancer(PLC).Methods From September 2018 to February 2020,162 patients who underwent laparoscopic hepatectomy without laparotomy in First Affiliated Hospital of Xinjiang Medical University were retrospectively enrolled,and divided into three groups.Group A 52 patients were received total hepatic inflow occlusion,group B 54 patients were received hemihepatic hepatic vascular exclusion,and group C 56 patients were received hemihepatic hepatic vascular exclusion combined with selective hepatic vascular exclusion.Then various indexes were compared among groups,including curative effect indicators[postoperative ventilation time,drainage tube indwelling time],liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)],cure rate and safety indicators(operating time,intraoperative blood loss,blood transfusion rate,postoperative complication rate,mortality rate).Results Intraoperative blood loss and intraoperative blood transfusion rate in group C[(148.77±31.33)mL,3.57%]were lower than those in group A and group B[(198.02±40.14)mL,9.26%;(229.63±48.36)mL,11.54%],the differences were statistically significant(P<0.05).Intraoperative blood loss and intraoperative blood transfusion rate in group B was lower than that in group A,the difference was statistically significant(P<0.05).Three days after operation,the levels of ALT,AST and TBIL in groups B and C were[(90.35±38.87)U/L,(85.56±20.11)U/L,(22.12±3.96)μmol/L;(88.98±35.46)U/L,(87.74±20.13)U/L,(21.37±4.01)μmol/L]were lower than those in group A[(201.03±58.62)U/L,(129.99±34.58)U/L,(36.63±4.57)μmol/L],the differences were statistically significant(P<0.05).The postoperative ventilation time,drainage tube indwelling time and postoperative hospital stay in groups B and C[(22.41±3.54)h,(9.03±1.06)d,(10.11±2.06)d;(20.55±3.48)h,(8.77±0.98)d,(10.02±2.03)d]were lower than those in group A[(30.22±4.65)h,(9.96±1.22)d,(11.54±2.30)d],the differences were statistically significant(P<0.05),and the cure rate(81.48%,87.50%)was higher than that in group A(57.69%),and the difference was statistically significant(P<0.05).The fatality rates of the three groups were 1.92%,0,0,and the difference was not statistically significant(P>0.05).The total postoperative complication rate in group C(3.57%)was lower than that in group A(26.92%),and the difference was statistically significant(P<0.05).Conclusion Application of hemihepatic hepatic vascular exclusion combined with selective hepatic vascular exclusion in laparoscopic hepatectomy for primary liver cancer can effectively protect the liver function of the residual liver,promote the postoperative recovery and improve the cure rate,with low intraoperative blood loss and complication rate.