Pringle法及Glisson鞘选择性入肝血流阻断法在肝脏切除手术中的效果及临床意义分析
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摘要
目的探讨Pringle法及Glisson鞘选择性入肝血流阻断法(SGPE)在肝脏切除手术中的效果及临床意义。方法选取2013年1月～2018年1月我院收治的腹腔镜下进行肝切除的患者82例,按照术中血流阻断方式的差异分为Pringle组(第一肝门血流阻断)和SGPE组(Glisson鞘选择性血流阻断)。研究对比两组患者术后肝脏功能、出血量、住院以及手术时间等指标的差异。结果 SGPE组住院时间、出血量以及手术时间均低于Pringle组(t=13.583,20.723,1.845;P=0.000,0.000,0.07),ALT水平均低于Pringle组(t=8.147,12.021,7.758,P=0.000,0.000,0.000);术后5d SGPE组患者前白蛋白水平高于Pringle组患者(t=10.589,14.508,9.223;P=0.000,0.000,0.000),白蛋白水平差异无统计学意义(P> 0.05)。结论在进行血流阻断时,应综合考虑到患者实际肝功能的差异,视患者实际的心血管条件进行选择,同时也要考虑到麻醉医师以及主治医师等操作习惯等因素,选择最适合患者自身的阻断方式。
Objective To explore the effect and clinical significance of Pringle method and Glisson sheath selective hepatic inflow occlusion(SGPE) in liver resection. Methods 82 patients underwent laparoscopic liver resection in our hospital from January 2013 to January 2018 were selected.According to different methods of intraoperative inflow occlusion,they were divided into the Pringle group(first porta hepatis inflow occlusion)and the SGPE group(Glisson sheath selective hepatic inflow occlusion).Postoperative liver function,bleeding volume,hospital stay and operative time of patients in the two groups were studied and compared. Results Hospital stay,bleeding volume and operative time of the SGPE group were all lower than that of Pringle group(t=13.583,20.723,1.845;P=0.000,0.000,0.07).The ALT level was lower than the Pringle group(t=8.147,12.021,7.758;P=0.000,0.000,0.000).The prealbumin level in the SGPE group was higher than that in the Pringle group(t=10.589,14.508,9.223;P=0.000,0.000,0.000),and difference in the prealbumin level was not significant(P > 0.05). Conclusion In the inflow occlusion,the difference in the actual liver function of patients should be taken into account comprehensively,and the choice should be made according to the actual cardiovascular conditions of patients.At the same time,factors such as the operation habits of anesthesiologists and attending physicians should also be taken into account to select the most suitable blocking mode for patients themselves.
Objective To explore the effect and clinical significance of Pringle method and Glisson sheath selective hepatic inflow occlusion(SGPE) in liver resection. Methods 82 patients underwent laparoscopic liver resection in our hospital from January 2013 to January 2018 were selected.According to different methods of intraoperative inflow occlusion,they were divided into the Pringle group(first porta hepatis inflow occlusion)and the SGPE group(Glisson sheath selective hepatic inflow occlusion).Postoperative liver function,bleeding volume,hospital stay and operative time of patients in the two groups were studied and compared. Results Hospital stay,bleeding volume and operative time of the SGPE group were all lower than that of Pringle group(t=13.583,20.723,1.845;P=0.000,0.000,0.07).The ALT level was lower than the Pringle group(t=8.147,12.021,7.758;P=0.000,0.000,0.000).The prealbumin level in the SGPE group was higher than that in the Pringle group(t=10.589,14.508,9.223;P=0.000,0.000,0.000),and difference in the prealbumin level was not significant(P > 0.05). Conclusion In the inflow occlusion,the difference in the actual liver function of patients should be taken into account comprehensively,and the choice should be made according to the actual cardiovascular conditions of patients.At the same time,factors such as the operation habits of anesthesiologists and attending physicians should also be taken into account to select the most suitable blocking mode for patients themselves.
引文
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[10]杨松柏.腹腔镜与开腹肝切除术对比治疗肝癌的临床效果[J].现代诊断与治疗,2017,28(9):1690-1691.
[11]张万广,柴松山.不同肝血流阻断方式在腹腔镜肝切除术中的应用评价[J].中国实用外科杂志,2017,37(5):469-473.
[12]李鹏鹏,刘辉,傅思源,等.肝脏三维可视化技术在第二肝门区肿瘤手术切除中的应用[J].中华外科杂志,2016,54(9):675-679.
[13]岑荣飞.选择性肝血流阻断技术用于腹腔镜下左半肝切除术效果观察[J].山东医药,2016,56(24):47-48.
[14]王莉荔,冯聪,沈洪,等.肝切除术中肝脏血流阻断技术的研究进展[J].中华肝胆外科杂志,2017,23(5):354-355.
[15]熊锐,尹涛,段传谊,等.Glisson蒂横断法原位扩大右后叶肝切除在原发性肝癌治疗中的临床应用[J].中国普通外科杂志,2018(1):121-124.
[16]蔡建平,王亚东,薛焕洲.保留半肝血流阻断法对肝癌模型大鼠抑瘤作用及肝功能的影响[J].中华实验外科杂志,2017,34(4):591-594.
[17]蔡柳新,艾合买提·乌麦尔,阿布都萨塔尔·艾萨,等.腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病[J].中华普通外科杂志,2016,31(9):743-746.
[2]钟鼎文,谢元才,叶荣强,等.半肝血流阻断技术在解剖性腹腔镜左半肝切除术中的应用[J].重庆医学,2017(A02):142-144.
[3]范应方,向飞,蔡伟,等.三维腹腔镜Glisson鞘内血管离断法解剖性肝切除术的临床分析[J].中华外科杂志,2016,54(3):191-195.
[4]叶培军,王云检.选择性入肝血流阻断在左半肝切除术中的作用研究[J].中国现代医学杂志,2018,28(5):82-86.
[5]隋承军,张敏峰,戴炳华,等.半肝血流完全阻断法在肝细胞癌肝切除术中的应用:前瞻性随机对照研究[J].第二军医大学学报,2016,37(10):1230-1238.
[6]夏志超,曾仲,夏仁品,等.腹腔镜肝左外叶切除三种血流阻断方法的比较[J].中国普通外科杂志,2016,25(9):1336-1340.
[7]周进学,王征征,李庆军,等.精准肝切除治疗邻近重要管道肝肿瘤的临床疗效[J].中华消化外科杂志,2017,16(2):139-143.
[8]刘允怡,赖俊雄.肝癌肝切除手术方式的理论基础及临床价值[J].中国实用外科杂志,2018,38(4):345-348.
[9]刘荣,王斐.腹腔镜肝切除手术入路合理选择及评价[J].中国实用外科杂志,2017,37(5):466-468.
[10]杨松柏.腹腔镜与开腹肝切除术对比治疗肝癌的临床效果[J].现代诊断与治疗,2017,28(9):1690-1691.
[11]张万广,柴松山.不同肝血流阻断方式在腹腔镜肝切除术中的应用评价[J].中国实用外科杂志,2017,37(5):469-473.
[12]李鹏鹏,刘辉,傅思源,等.肝脏三维可视化技术在第二肝门区肿瘤手术切除中的应用[J].中华外科杂志,2016,54(9):675-679.
[13]岑荣飞.选择性肝血流阻断技术用于腹腔镜下左半肝切除术效果观察[J].山东医药,2016,56(24):47-48.
[14]王莉荔,冯聪,沈洪,等.肝切除术中肝脏血流阻断技术的研究进展[J].中华肝胆外科杂志,2017,23(5):354-355.
[15]熊锐,尹涛,段传谊,等.Glisson蒂横断法原位扩大右后叶肝切除在原发性肝癌治疗中的临床应用[J].中国普通外科杂志,2018(1):121-124.
[16]蔡建平,王亚东,薛焕洲.保留半肝血流阻断法对肝癌模型大鼠抑瘤作用及肝功能的影响[J].中华实验外科杂志,2017,34(4):591-594.
[17]蔡柳新,艾合买提·乌麦尔,阿布都萨塔尔·艾萨,等.腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病[J].中华普通外科杂志,2016,31(9):743-746.