不同肝血流阻断方式在腹腔镜左半肝切除术肝癌患者中的应用

Application of different ways of hepatic blood flow occlusion in patients with liver cancer undergoing laparoscopic left hemihepatectomy

目的探讨不同肝血流阻断方式对腹腔镜左半肝切除术肝癌患者中的应用效果。方法回顾性选取75例接受腹腔镜左半肝切除术治疗治疗的肝癌患者,根据不同肝血流阻断方式分为A组、B组与C组,各25例。A组实施Pringle法,B组实施左半肝鞘内解剖血流阻断法,C组实施左半肝鞘内解剖血流阻断+左肝静脉阻断法,3组术后均随访3个月。比较3组围手术期相关指标,术前和术后3 d肝功能、免疫功能、血清细胞间黏附分子-1(ICAM-1)、巨噬细胞移动抑制因子(MIF)、C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8水平,术前和术后3个月后生命质量及随访期间并发症发生情况。结果C组术中出血量低于A组、B组,B组低于A组(P<0.05);C组肛门排气时间、下床活动时间、住院时间短于A组、B组,B组短于A组(P<0.05)。与术前比较,3组术后3 d血清总胆红素(TBIL)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、ICAM-1、CRP、IL-6、IL-8水平升高,C组低于A组、B组,B组低于A组(P<0.05);血清前白蛋白(PA)水平及外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平降低,C组高于A组、B组,B组高于A组(P<0.05);血清MIF水平降低,C组低于A组、B组,B组低于A组(P<0.05)。与术前比较,3组术后3个月的症状/不良作用、社会功能、躯体功能、心理功能评分升高,C组高于A组、B组,B组高于A组(P<0.05)。C组随访期间并发症总发生率低于A组、B组(P<0.05)。结论与Pringle法和左半肝鞘内解剖血流阻断法相比,左半肝鞘内解剖血流阻断法+左肝静脉阻断法可有效控制腹腔镜左半肝切除术肝癌患者术中出血,有效调节患者血清ICAM-1、MIF、CRP、IL-6、IL-8水平,减轻炎症反应,改善患者肝功能和免疫功能,促进患者术后恢复,缩短住院时间,提高生命质量,具有较好的安全性。

Objective To explore the application effects of different ways of hepatic blood flow occlusion in patients with liver cancer undergoing laparoscopic left hemihepatectomy.Methods 75 patients with liver cancer who underwent laparoscopic left hemihepatectomy were selected and divided into group A,group B and group C according to different ways of hepatic blood flow occlusion,with 25 cases in each group.Group A implemented the Pringle method,group B implemented the left hemihepatic sheath dissection blood flow occlusion method,and group C implemented the left hemihepatic sheath dissection blood flow occlusion and left hemihepatic veins exclusion.Three groups were followed up for 3 months after surgery.The perioperative related indexes of three groups were compared,including liver function,immune function,and levels of serum intercellular adhesion molecule-1(ICAM-1),macrophage movement inhibitory factor(MIF),C-reactive protein(CRP),interleukin(IL)-6 and IL-8 before surgery and at 3 days after surgery.Quality of life and incidence of complications during the follow-up period before surgery and at 3 months after surgery of three groups were compared.Results The amount of intraoperative bleeding in group C was lower than that in group A and group B,and group B was lower than group A(P<0.05).The time of anal exhaust,the time of out of bed activiry and hospital stay in group C were shorter than those in group A and group B,and group B was shorter than group A(P<0.05).Compared with before surgery,the levels of serum total bilirubin(TBIL),aspartate aminotransferase(AST),alkaline phosphatase(ALP),ICAM-1,CRP,IL-6,and IL-8 of three groups were increased at 3 days after surgery,and group C was lower than group A and group B,and group B was lower than group A(P<0.05);the levels of serum prealbumin(PA)and peripheral blood CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and NK cell were decreased,and group C was higher than group A and group B,and the group B was higher than group A(P<0.05);the level of serum MIF was decreased,and group C was lower than group A and group B,and group B was lower than group A(P<0.05).Compared with before surgery,the scores of symptoms/adverse effects,social function,somatic function,and psychological function at 3 months after surgery of three groups were increased,and gruop C was higher than group A and group B,and group B was higher than group A(P<0.05).The overall incidence of complications during the follow-up period in group C was lower than that in grou A and group B(P<0.05).Conclusion Compared with the Pringle method and the left hemihepatic sheath dissection blood flow occlusion method,the left hemihepatic sheath dissection blood flow occlusion method and left hemihepatic veins exclusion method can effectively control intraoperative bleeding in liver cancer patients undergoing laparoscopic left hemihepatectomy,regulate the serum levels of ICAM-1,MIF,CRP,IL6,and IL-8 of patients,alleviate inflammation reactions,improve hepatic and immune functions of patients,which can promote postoperative recovery,shorten hospital stay,and improve the quality of life,with good safety.