不同入肝血流阻断技术下腹腔镜肝切除术治疗原发性肝癌的临床研究

Clinical study of laparoscopic hepatectomy for primary liver cancer with different hepatic flow blocking techniques

目的分析不同入肝血流阻断技术下腹腔镜肝切除术治疗原发性肝癌的临床效果。方法选取焦作市第二人民医院2020年1月至2023年10月收治的80例原发性肝癌患者为研究对象,按照随机数字表法分为对照组与试验组,每组40例。对照组采取Pringle法血流阻断,试验组采用半肝血流阻断(HVC)。比较两组围术期指标(阻断时间、术中出血量、输血量、住院天数、操作时间)、肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)]水平、肠黏膜屏障(内毒素、D⁃乳酸)及并发症发生率。结果与对照组比较,试验组术中出血量、输血量较少,且操作时间、住院天数较短(P<0.05)。与对照组比较,术后3 d、7 d试验组患者ALT、ALB、AST水平较低(P<0.05)。与对照组比较,术后7 d试验组患者内毒素、D⁃乳酸水平较低(P<0.05)。试验组并发症发生率[5.00%(2/40)]与对照组[15.00%(6/40)]比较,差异未见统计学意义(P>0.05)。结论HVC法阻断技术下腹腔镜肝切除术治疗原发性肝癌患者能减轻手术创伤,降低对肝功能的损伤,减轻肠黏膜屏障受损程度,且该方案具有较高的治疗安全性。

Objective To analyze the clinical effects of laparoscopic hepatectomy with different hepatic blood flow blocking techniques on primary liver cancer.Methods A total of 80 patients with primary liver cancer in the Second People's Hospital of Jiaozuo from January 2020 to October 2023 were selected and divided into experimental group and control group according to random number table method,with 40 cases in each group.The control group underwent blood flow blockade by Pringle method,and hemihepatic vascular control(HVC)was used in the experimental group.The perioperative parameters(blocking time,intraoperative blood loss,blood transfusion,hospital stay,operation time),liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB)](AST),intestinal mucosal barrier(endotoxin,D⁃lactic acid)and complication rate were compared between the two groups.Results Compared with the control group,the experimental group had less blood loss and blood transfusion,and the operation time and hospitalization days were shorter(P<0.05).Compared with the control group,the levels of ALT,ALB and AST in experimental groups were lower at 3 and 7 days after surgery(P<0.05).Compared with the control group,the levels of endotoxin and D⁃lactic acid in experimental group were lower at 7 days after operation(P<0.05).There was no significant difference in the complication rate between the experimental group[5.00%(2/40)]and the control group[15.00%(6/40)](P>0.05).Conclusions HVC block technique in the treatment of primary liver cancer patients with laparoscopic hepatectomy can reduce the surgical trauma,reduce the damage to liver function and the damage of intestinal mucosal barrier,and this protocol has a high treatment safety.