中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜入肝血流阻断方案对肝细胞癌合并肝硬变患者肝切除的安全性对比

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目的 探讨间歇性 Pringle(IP)和持续性半肝血流阻断(CHVIO)对接受腹腔镜肝切除术的肝细胞癌合并肝硬变患者术后转归的影响。 方法 回顾性分析 2015 年 1 月到 2017 年 12 月期间在四川大学华西医院行腹腔镜肝切除的 107 例肝细胞癌合并肝硬变患者的临床资料,根据肝血流阻断方法分为 IP 组和 CHVIO 组,比较 2 组患者的术中和术后效果指标,以及短期预后。 结果 IP 组患者的术中出血量 [(279±24)mL 比(396±35)mL,P=0.012)] 和手术时间 [(237±90)min 比(285±118)min,P=0.041)] 均少于 CHVIO 组,但 2 组的术后肝功能(包括 ALT、AST、TBIL 和 ALB 水平)、并发症发生情况、引流量、1 年无瘤生存情况和 1 年生存情况比较差异均无统计学意义(P>0.05)。 结论 LLR 中采用 IP 可减少肝细胞癌合并肝硬变患者的手术时间和出血量,且不会导致术后肝功能恶化,是值得推荐的入肝血流阻断方法。

Objective To investigate the effect of intermittent Pringle (IP) and continuous hemi-hepatic vascular inflow occlusion (CHVIO) on the prognosis of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis in laparoscopic liver resection (LLR). Methods Retrospective analysis of consecutive 107 LLR patients with HCC complicated with liver cirrhosis at West China Hospital of Sichuan University between January 2015 and December 2017 was performed. Patients were divided into an IP group and a CHVIO group according to the method of hepatic vascular occlusion, intraoperative and postoperative outcome indicators and short-term prognosis were compared between the two groups. Results Patients in the IP group had shorter operative time [(237+90) min vs (285+118) min, P=0.041] and less blood loss [(279+24) mL vs (396+35) mL, P=0.012], without a significant increase in postoperative liver function [including ALT, AST, TBIL, and ALB], postoperative complications, induced flow, 1-year disease-free survival, and1-year survival (P>0.05). Conclusions IP can reduce the operative time and blood loss in patients with HCC complicated with cirrhosis in LLR, and will not lead to deterioration of liver function, it is a recommended hepatic inflowocclusion method.

关键词: 肝细胞癌; 肝硬变; 间歇性 Pringle 法; 连续半肝血流阻断; 腹腔镜肝切除; 倾向评分匹配

Key words: hepatocellular carcinoma; liver cirrhosis; intermittent Pringle maneuver; continuous hemi-hepatic vascular inflow occlusion; laparoscopic liver resection; propensity score matching

引用本文: 冶俊山, 魏永刚, 蓝翔, 刘非, 李波, 张华, 徐洪卫, 何仲平, 赵荣策, 王琳媛. 腹腔镜入肝血流阻断方案对肝细胞癌合并肝硬变患者肝切除的安全性对比. 中国普外基础与临床杂志, 2019, 26(2): 141-147. doi: 10.7507/1007-9424.201811084 复制

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