Pringle法肝血流阻断联合控制性低中心静脉压对腹腔镜肝切除术的影响

Effect of Pringle Hepatic Blood Flow Occlusion Combined with Controlled Low Central Venous Pressure on Laparoscopic Hepatectomy

目的探讨Pringle法肝血流阻断联合控制性低中心静脉压对腹腔镜肝切除术的影响。方法回顾性分析内江市第二人民医院肝胆外科2018年1月至2020年6月收治的肝脏肿瘤患者126例,均采用腹腔镜肝脏切除术,其中采用Pringle法肝血流阻断联合控制性低中心静脉压67例(观察组),采用Pringle法肝血流阻断并且未控制中心静脉压59例(对照组)。分析并比较两组患者术前、术中、术后的相关临床资料。结果两组患者术前资料包括性别、年龄、肝功能Child-Pugh分级、肝功能指标、凝血酶原时间等差异均无统计学意义(P>0.05)。两组患者均顺利完成手术,无中转开腹,无围手术期死亡病例。观察组术中肝血流阻断时间、术中出血量、肝切除时间、输血量均低于对照组,差异有统计学意义(P<0.05)。两组患者术后出血、胆汁漏、肝断面感染、肝功能、住院时间比较均无统计学差异(P>0.05),但观察组术后乳酸高于对照组(P<0.05)。结论Pringle法肝血流阻断联合控制性低中心静脉压在腹腔镜肝切除术中的应用是安全可靠的。

Objective To investigate the effect of Pringle method combined with controlled low central venous pressure on laparoscopic hepatectomy.Methods 126 patients with liver tumor in Department of hepatobiliary surgery of the Second People’s Hospital of Neijiang City from January 2018 to June 2020 were retrospectively analyzed.All patients were treated with laparoscopic hepatectomy,including 67 patients with Pringle hepatic blood flow occlusion combined with controlled low central venous pressure(observation group),and 59 patients with Pringle hepatic blood flow occlusion combined with uncontrolled central venous pressure(control group).The clinical data of the two groups before,during and after operation were analyzed and compared.Results There were no significant differences in gender,age,child Pugh grade of liver function,liver function index and prothrombin time between the two groups(P>0.05).There was no conversion to laparotomy or perioperative death.The time of hepatic blood flow blocking,the amount of blood loss,the time of hepatectomy and the amount of blood transfusion in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in postoperative bleeding,bile leakage,liver cross-section infection,liver function and hospital stay between the two groups(P>0.05),but the vaule of postoperative lactic acid in the observation group was higher than that in the control group(P<0.05).Conclusion The application of Pringle hepatic blood flow occlusion combined with controlled low central venous pressure in laparoscopic hepatectomy is safe and reliable.