腹腔镜复杂性肝脏切除术中行CLCVP对肝癌患者围术期指标及预后的影响

摘要/Abstract

摘要： 目的研究腹腔镜复杂性肝脏切除术中行控制性低中心静脉压(CLCVP)对肝癌患者围术期指标及预后的影响。方法选取2018年5月至2019年5月收治的124例原发性肝癌(PLC)患者纳入研究对象,所有患者入院后依据随机数表法进行分组,分为腹腔镜+CLCVP组与对照组,每组62例。对照组于腹腔镜下行复杂性肝脏切除术,观察组在对照组的基础上行CLCVP。对比两组患者围术期相关临床指标(手术时间、术中出血量、术中输血量、肝门阻断时间、住院时间)差异;对比两组手术前后血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酐(Cr)、血尿素氮(BUN)水平差异;统计两组患者术后住院期间并发症发生情况;最后对两组患者均行1年院外随访,统计两组患者术后1年生存率。结果腹腔镜+CLCVP组围术期各项指标均优于对照组于对照组,P<0.05。两组术前ALT、AST、Cr、BUN及术后3 d、7 d时Cr、BUN水平对比,P>0.05;腹腔镜+CLCVP组术前术后3 d、7 d时ALT、AST水平显著低于对照组,P<0.05。两组术后并发症总发生率对比,9.68% vs 6.45%,P>0.05。两组术后随访1年期间无失访,两组术后1年生存率对比差异无统计学意义(82.26% vs 80.65%,P>0.05)。结论 PLC患者腹腔镜复杂性肝脏切除术中行CLCVP能够缩短手术时间及住院时间、减少术中出血量,且不增加手术治疗的并发症、不影响患者预后。

关键词: 原发性肝癌, 腹腔镜, 肝脏切除术, 肝功能, 并发症, 预后

Abstract: Objective To investigate the influence of controlled low central venous pressure (CLCVP) in complex laparoscopic hepatectomy on perioperative indicators and prognosis of liver cancer patients. Methods A total of 124 patients with primary liver cancer (PLC) admitted to our hospital from May 2018 to May 2019 were included in the study. They were divided into an observation group and a control group according to the random number table, with 62 patients in each group. The control group underwent complex laparoscopic hepatectomy, and the observation group underwent CLCVP added to complex laparoscopic hepatectomy. The perioperative clinical indicators (operation time, intraoperative blood loss, intraoperative blood transfusion, portal block time and hospital stay) and incidence of postoperative complications were compared between the 2 groups. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), and blood urea nitrogen (BUN) levels were compared before and after surgery in the 2 groups. Moreover, the patients in both groups were followed up for 1 year after operation, and the 1-year postoperative survival rate was calculated. Results All the perioperative indexes in the observation group were better than those in the control group (P<0.05). There was no significant difference in the levels of ALT, AST, SCr, BUN before operation, or the levels of SCr and BUN 3 and 7 days after operation between the 2 groups (P>0.05). The levels of ALT and AST in the observation group were significantly lower than those in the control group before operation, 3 and 7 days after operation (P<0.05). There was no significant difference in the incidence of postoperative complications between the 2 groups (9.68% vs 6.45%, P>0.05). With no cases lost during the 1-year follow-up, there was no statistical difference in the 1-year postoperative survival rate between the 2 groups (82.26% vs 80.65%, P>0.05). Conclusion CLCVP during complex laparoscopic hepatectomy shortens the operation time and hospital stay, reduces intraoperative blood loss, and has no adverse effect on the complications and prognosis of patients with primary liver cancer.

Key words: Primary liver cancer, Laparoscope, Hepatectomy, Liver function, Complications, Prognosis

吕发凯, 王登基, 谢钰辉, 张宇. 腹腔镜复杂性肝脏切除术中行CLCVP对肝癌患者围术期指标及预后的影响[J]. 肝脏, 2021, 26(7): 761-764.

LV Fa-kai, WANG Deng-ji, XIE Yu-hui, ZHANG Yu. Effect of CLCVP during complex laparoscopic hepatectomy on perioperative indicators and prognosis in patients with hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(7): 761-764.

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