血流阻断对腹腔镜解剖性肝切除患者凝血和肝功能的影响

Effects of Blood Flow Occlusion on Coagulation and Liver Function in Patients With Laparoscopic Anatomical Hepatectomy

目的探讨血流阻断对腹腔镜解剖性肝切除患者凝血和肝功能的影响。方法回顾分析2017年6月—2021年6月宁德师范学院附属宁德市医院行腹腔镜解剖性肝切除术60例,分为Pringle组和区域阻断组各30例。监测手术时间、术中出血量、术后凝血酶原时间(prothrombin time,PT)、丙氨酸氨基转移酶(alanine transaminase,ALT)、天门冬氨酸氨基转移酶(aspartate transaminase,AST)和总胆红素(total bilirubin,TBIL)的变化。结果Pringle组vs.区域血流阻断组:手术时间(172.5±75.7)min vs.(142.6±52.8)min,差异有统计学意义(P<0.05);术中出血量(425.2±165.4)mL vs.(365.0±142.6)mL,差异有统计学意义(P<0.05);术后第1天PT(13.5±3.4)s vs.(12.6±2.5)s,差异有统计学意义(P<0.05);术后第1天和术后第3天的ALT(214.5±152.8)U/L vs.(177.4±102.8)U/L、(143.6±89.4)U/L vs.(127.6±56.2)U/L,差异有统计学意义(P<0.05);术后第1天和术后第3天的AST(235.8±146.4)U/L vs.(187.5±115.6)U/L、(146.6±95.2)U/L vs.(122.4±66.5)U/L,差异有统计学意义(P<0.05);术后第5天两组ALT、AST基本接近正常,差异无统计学意义(P>0.05),术后TBIL两组无明显升高,差异无统计学意义(P>0.05),两组均未出现严重并发症。结论区域阻断入肝血流能减轻术后早期凝血功能和肝功能损伤,更好地控制切肝时间和术中出血量,对患者术后恢复是有利的。

Objective To investigate the effect of blood flow occlusion on coagulation and liver function in patients with laparoscopic anatomical hepatectomy.Methods From June 2017 t o J u n e 2021,a t o t a l o f 60 c a s e s o f l a p a r o s c o p i c anatomical hepatectomy were retrospectively analyzed in Ningde Municipal Hospital of Ningde Normal University,with 30 cases in the Pringle group and 30 cases in the regional block group.Changes in operation time,intraoperative blood loss,postoperative prothrombin time(PT),alanine transaminase(ALT),aspartate transaminase(AST)and total bilirubin(TBIL)were monitored.Results The Pringle group vs.the regional blood flow occlusion group:operation time(172.5±75.7)min vs.(142.6±52.8)min,the difference was statistically significant(P<0.05).Intraoperative blood loss was(425.2±165.4)mL vs.(365.0±142.6)mL,the difference was statistically significant(P<0.05).PT(13.5±3.4)s vs.(12.6±2.5)s on the first day after surgery,the difference was statistically s i g n i f i c a n t(P<0.05).A LT(214.5±152.8)U/L v s.(177.4±102.8)U/L,(143.6±89.4)U/L vs.(127.6±56.2)U/L on the first and third day after surgery,the differences were statistically significant(P<0.05).The AST of the first and third postoperative days was(235.8±146.4)U/L vs.(187.5±115.6)U/L,(146.6±95.2)U/L vs.(122.4±66.5)U/L,and the differences were statistically significant(P<0.05).On the 5th day after surgery,ALT and AST were close to normal,and the difference was not statistically significant(P>0.05).Postoperative TBIL was not significantly increased between the two groups(P>0.05),and there were no serious complications in the two groups.Conclusion Regional occlusion of blood flow into the liver can reduce the early postoperative coagulation function and liver function damage,and better control the time of hepatectomy and intraoperative blood loss,which is beneficial to the postoperative recovery of patients.