半肝血流阻断配合间歇性Pringle法在巨大肝癌切除术中的应用比较

The application of hemihepatic blood flow occlusion combined with intermittent Pringle method in the resection of giant liver cancer

目的探讨半肝血流阻断配合间歇性Pringle法在巨大肝癌切除术中的应用。方法选取2019年1月至2021年12月南京医科大学附属苏州医院78例行巨大肝癌切除术的肝癌患者,按照术中血流阻断方法分为半肝组、实验组,各39例。半肝组采用半肝血流阻断,实验组采用半肝血流阻断配合间歇性Pringle法。比较实验组与半肝组的围术期指标,于术前、术后1 d、3 d、5 d检测肝功能指标,统计术后3个月内并发症及肝癌患者生命质量测定量表(QLI-LC评分)。结果半肝组术中出血量为(198.24±34.15)mL,住院时间为(9.58±1.36)d,实验组为(163.28±26.47)mL,(8.15±1.20)d(P<0.05)。两组术后1 d、3 d、5 d肝功能指标均先升高后降低(P<0.05);但各个时间点两组间肝功能指标比较差异无统计学意义(P>0.05)。半肝组并发症发生率25.64%(10/39),实验组7.69%(3/39)(P<0.05)。与术后3个月半肝组躯体功能(21.38±4.98)分、症状体征(17.87±3.76)分、心理功能(13.15±2.03)分、社会功能(14.28±2.75)分比较,实验组躯体功能(12.87±3.21)分、症状体征(10.09±2.21)分、心理功能(7.09±1.92)分、社会功能(9.27±1.04)分更低(P<0.05)。结论半肝血流阻断配合间歇性Pringle法应用于巨大肝癌切除术中能减少出血量,促进术后恢复,提高生活质量,且不会加重肝损伤及并发症的发生,安全性高。

Objective To explore the application effect of hemihepatic blood flow occlusion combined with intermittent Pringle method in the resection of giant liver cancer.Methods From January 2019 to December 2021,seventy-eight patients with liver cancer who underwent giant liver cancer resection were selected from Suzhou Hospital affiliated to Nanjing Medical University.They were divided into a semihepatic group and an experimental group with thirty-nine cases in each group.The semihepatic group was treated with half hepatic blood flow occlusion,and the experimental group was treated with half hepatic blood flow occlusion in combination with intermittent Pringle method.The perioperative indicators of the experimental group and the semihepatic group were compared.The relevant indicators of liver function before operation and at 1 day,3 days and 5 days after operation were detected and analyzed.The complications and quality of life within 3 months after operation[Quality of life measurement scale for liver cancer patients(QLI-LC score)]were counted.Results Compared with the semihepatic group,the experimental group had less intraoperative bleeding[(163.28±26.47)ml vs 198.24±34.15)ml]and shorter hospital stay[(8.15±1.20)d vs(9.58±1.36)d](P<0.05).The liver function indicators of the two groups increased at 1 day,3 days and 5 days after operation and decreased thereafter(P<0.05).However,there was no difference in liver function parameters between the two groups at each time point(P>0.05).The incidence of complications in the experimental group was 7.69%,which was significantly lower than that of 25.64%in the semihepatic group(P<0.05).When compared the QLI-LC score at three and a half months after operation,the physical function(12.87±3.21),symptoms and signs(10.09±2.21),psychological function(7.09±1.92),and social function(9.27±1.04)in the experimental groups was lower than those of(21.38±4.98),(17.87±3.76),(13.15±2.03),and(14.28±2.75)respectively,in the semihepatic group(P<0.05).Conclusion The application of hemihepatic blood flow occlusion combined with intermittent Pringle method in the resection of giant liver cancer can reduce intraoperative bleeding,promote postoperative recovery,improve the quality of life with high safety,without aggravating the occurrence of liver injury and complications.