选择性肝血流阻断与全肝门血流阻断对腹腔镜左半肝切除术后肝脏缺血再灌注损伤的影响

Effect of Selective Hepatic Blood Flow Blocking and Whole Hepatic Portal Blood Flow Blocking on Hepatic Ischemia-reperfusion Injury after Laparoscopic Left Hemihepatectomy

目的研究两组不同肝血流阻断方式对腹腔镜左半肝切除术后肝脏缺血再灌注损伤程度影响的比较分析。方法回顾性分析2018年1月-2021年12月期间因左肝肿瘤在福建医科大学附属闽东医院接受腹腔镜下左半肝切除术患者46例的临床资料,A组(25例)采用选择性肝血流阻断、B组(21例)采用全肝门血流阻断。比较两组手术情况及术前、术后第1天肝功能指标、炎症细胞因子水平的变化。结果两组患者手术时长[(163.57±9.41)min vs(159.76±10.47)min]、术中出血量[(135.85±11.45)mL vs(130.71±10.27)mL]、住院时间[(7.19±0.98)d vs(6.72±0.87)d]比较,差异无统计学意义(t=1.300、1.586、1.705,P>0.05);术后第1天,A组的血清肝功能指标(ALT、AST、TBIL)及炎症因子(CRP、IL-6、IL-8、WBC)均明显低于B组,差异有统计学意义(P<0.05)。结论选择性左半肝血流阻断并不会延长手术时间及增加术中出血量,能够有效减轻术后肝功能损害及炎症反应,降低肝脏缺血后的再灌注损伤。

Objective To compare the effects of different hepatic blood flow blocking methods on the degree of hepatic ischemia-reperfusion injury after laparoscopic left hemihepatectomy between two groups.Methods Retrospective analysis of the clinical data of 46 patients who underwent laparoscopic left hemihepatectomy for left liver tumor in Mindong Hospital affiliated to Fujian Medical University from January 2018 to December 2021.Group A(25 cases)received selective hepatic blood flow occlusion,while group B(21 cases)received total hepatic portal blood flow occlusion.The operation and the changes of liver function indexes and inflammatory cytokines before and on day 1 after operation were compared between the two groups.Results There was no statistically significant difference between the two groups in surgical duration[(163.57±9.41)min vs(159.76±10.47)min],intraoperative blood loss[(135.85±11.45)mL vs(130.71±10.27)mL],hospital stay[(7.19±0.98)d vs(6.72±0.87)d](t=1.300,1.586,1.705,P>0.05);on day 1 after surgery,the serum liver function indexes(ALT,AST,TBIL)and inflammatory factors(CRP,IL-6,IL-8,WBC)in group A were significantly lower than those in group B,the difference was statistically significant(P<0.05).Conclusion Selective left liver blood flow blocking does not prolong operation time or increase intraoperative blood loss,but can effectively reduce postoperative liver function damage and inflammatory reaction,and reduce reperfusion injury after liver ischemia.