选择性半肝血管阻断与Pringle法在肝肿瘤肝切除术中的应用效果比较

Comparison of Selective Hemihepatic Vascular Occlusion and Pringle Method in Hepatectomy of Liver Tumor

目的比较半入肝血流阻断(HHO)与Pringle法对手术治疗肝肿瘤患者术中及术后临床指标的影响。方法选取2018年10月至2020年7月在内蒙古医科大学附属医院肝胆胰脾外科行手术治疗的50例肝肿瘤患者,采用随机数字表法分为Pringle组(22例)和HHO组(28例)。两组均在全身麻醉下入腹游离肝周韧带,确定肿瘤所在肝段,Pingle组和HHO组分别采用Pringle法或HHO法阻断入肝血流后行肝肿瘤切除术。记录并比较两组术中和术后相关指标、手术前后肝功能指标变化以及术后并发症发生情况。结果两组术中肝血流阻断时间、手术时间、出血量、单位面积出血量、输血和半肝切除比例比较差异无统计学意义(P>0.05)。两组肿瘤最大直径、肿瘤病理组织学类型比较差异无统计学意义(P>0.05),HHO组住院时间、住院费用均少于Pringle组[15.0(12.3,16.0)d比18.0(15.8,21.0)d,35433(32568,39591)元比43756(36195,50781)元](Z=3.614,P<0.001;Z=2.756,P=0.006)。两组术前各项肝功能指标比较差异均无统计学意义(P>0.05),HHO组术后第1天、第3天、第7天的丙氨酸转氨酶、天冬氨酸转氨酶水平均低于Pringle组[174.0(137.6,218.5)U/L比451.8(353.2,632.9)U/L、140.3(102.5,196.7)U/L比389.4(242.8,550.1)U/L,84.5(55.0,117.2)U/L比246.4(158.2,308.7)U/L、34.4(26.3,61.4)U/L比91.1(59.4,152.0)U/L,28.6(21.3,37.4)U/L比65.2(36.3,99.3)U/L、19.8(15.8,24.2)U/L比30.5(22.5,41.9)U/L](P<0.01),但两组白蛋白、前白蛋白、总胆红素、结合胆红素比较差异无统计学意义(P>0.05)。两组总并发症发生率比较差异无统计学意义(P>0.05)。结论Pringle法和HHO用于肝肿瘤肝切除患者均安全有效,与Pringle法相比,HHO的肝损伤小、术后肝功能恢复快、住院时间短、住院费用低。

Objective To compare the effects of hemihepatic vascular occlusion(HHO)and Pringle method on intraoperative and postoperative clinical indexes in patients with liver tumors.Methods Fifty patients with liver tumors who underwent surgical treatment in the Department of Hepatobiliary Pancreatic Splenic Surgery of the Affiliated Hospital of Inner Mongolia Medical University from Oct.2018 to Jul.2020 were included and randomly divided into a Pringle group(22 cases)and an HHO group(28 cases).Under general anesthesia,free perihepatic ligament was inserted into the abdomen to determine the liver segment where the tumor was located.Pingle group and HHO group were treated with Pringle method or HHO method respectively to block the blood flow into the liver,and then liver tumor resection was performed.The intraoperative and postoperative related indexes,the changes of liver function indexes before and after operation and the incidence of postoperative complications were recorded and compared between the two groups.Results There was no statistically significant difference in the time of hepatic blood flow occlusion,operation time,blood loss,blood loss per unit area,blood transfusion amount,and the proportion of blood transfusion cases to hemihepatectomy cases between the two groups(P>0.05).There was no significant difference in the maximum diameter of the tumor and the histopathological type of the tumor between the two groups(P>0.05).The length of hospital stay and hospitalization expenses in the HHO group were lower than those in the Pringle group[15.0(12.3,16.0)d vs 18.0(15.8,21.0)d,35433(32568,39591)yuan vs 43756.4(36195,50781)yuan](Z=3.614,P<0.001;Z=2.756,P=0.006).There was no significant difference in preoperative liver function between the two groups(P>0.05),while the levels of alanine aminotransferase and aspartate aminotransferase in the HHO group were lower than those in the Pringle group on the 1st,3rd and 7th day after operation[174.0(137.6,218.5)U/L vs 451.8(353.2,632.9)U/L,140.3(102.5,196.7)U/L vs 389.4(242.8,550.1)U/L,84.5(55.0,117.2)U/L vs 246.4(158.2,308.7)U/L,34.4(26.3,61.4)U/L vs 91.1(59.4,152.0)U/L,28.6(21.3,37.4)U/L vs 65.2(36.3,99.3)U/L,19.8(15.8,24.2)U/L vs 30.5(22.5,41.9)U/L](P<0.01),however,there was no significant difference in albumin,prealbumin,total bilirubin and conjugated bilirubin between the two groups(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Pringle method and HHO are both safe and effective in patients with liver tumors undergoing hepatectomy.Compared with Pringle method,HHO is featured with less liver injury,faster recovery of postoperative liver function,shorter hospitalization time and lower hospitalization expenses.