控制性低中心静脉压在腹腔镜肝叶切除术中的应用
| 作者: |
1朱荣涛,
1郭文治,
1李捷,
2王勇,
1马秀现,
1张水军
1 郑州大学第一附属医院肝胆胰外科，河南 郑州450052 2 郑州大学第一附属医院麻醉科，河南 郑州450052 |
| 通讯: |
张水军
Email: zhangshuijun@zzu.edu.cn |
| DOI: | 10.3978/.2018.01.007 |
| 基金: | 河南省教育厅高等学校重点科研计划资助项目（16A320030）； 河南省卫计委医学科技攻关计划资助项目（201602065）。 |
摘要
目的：探讨控制性低中心静脉压（CLCVP）在腹腔镜肝叶切除术中应用的可行性及临床效果。
方法：回顾性分析郑州大学第一附属医院2013年9月—2017年7月施行的腹腔镜肝切除术97例患者的临床资料，其中术中应用CLCVP者53例（CLCVP组），未应用CLCVP者44例（对照组），两组患者按照肝切除范围又分为腹腔镜简单肝叶切除术（左外叶切除、边缘部分不规则肝叶）与腹腔镜复杂肝脏切除术（左半肝切除、右半肝切除、肝中叶切除）亚组，比较两组患者总体与亚组间的相关临床指标。
结果：全部患者均顺利完成手术，无围手术期死亡；无论总体还是亚组间比较，CLCVP组与对照组患者术中尿量、术后肝肾功能指标均无统计学差异（均P>0.05）；总体比较，CLCVP组与对照组切肝时间和术后住院时间亦均无统计学差异（均P>0.05）；CLCVP组术中出血量、输血例数、输血量均较对照组明显减少（P<0.05）；亚组比较，两组间腹腔镜简单肝叶切除术患者以上指标均无明显差异（均P>0.05），但CLCVP组中腹腔镜复杂肝脏切除术患者的术中出血量、输血例数、输血量均明显少于对照组中腹腔镜复杂肝脏切除术患者（均P<0.05）；术后Clavien-Dindo III级以上并发症CLCVP组及对照组分别出现6例和5例（P>0.05）；全部患者术中及术后均未出现有临床症状的肺栓塞。
结论：对于腹腔镜复杂性肝脏切除术患者，术中行CLCVP能有效减少出血量、输血量，且并无增加肺栓塞的危险。
关键词：
肝切除术；腹腔镜；中心静脉压；降压，控制性
方法：回顾性分析郑州大学第一附属医院2013年9月—2017年7月施行的腹腔镜肝切除术97例患者的临床资料，其中术中应用CLCVP者53例（CLCVP组），未应用CLCVP者44例（对照组），两组患者按照肝切除范围又分为腹腔镜简单肝叶切除术（左外叶切除、边缘部分不规则肝叶）与腹腔镜复杂肝脏切除术（左半肝切除、右半肝切除、肝中叶切除）亚组，比较两组患者总体与亚组间的相关临床指标。
结果：全部患者均顺利完成手术，无围手术期死亡；无论总体还是亚组间比较，CLCVP组与对照组患者术中尿量、术后肝肾功能指标均无统计学差异（均P>0.05）；总体比较，CLCVP组与对照组切肝时间和术后住院时间亦均无统计学差异（均P>0.05）；CLCVP组术中出血量、输血例数、输血量均较对照组明显减少（P<0.05）；亚组比较，两组间腹腔镜简单肝叶切除术患者以上指标均无明显差异（均P>0.05），但CLCVP组中腹腔镜复杂肝脏切除术患者的术中出血量、输血例数、输血量均明显少于对照组中腹腔镜复杂肝脏切除术患者（均P<0.05）；术后Clavien-Dindo III级以上并发症CLCVP组及对照组分别出现6例和5例（P>0.05）；全部患者术中及术后均未出现有临床症状的肺栓塞。
结论：对于腹腔镜复杂性肝脏切除术患者，术中行CLCVP能有效减少出血量、输血量，且并无增加肺栓塞的危险。
Application of controlled low central venous pressure in laparoscopic hepatic lobectomy
CorrespondingAuthor:ZHANG Shuijun Email: zhangshuijun@zzu.edu.cn
Abstract
Objective: To investigate the feasibility and clinical efficacy of using controlled low central venous pressure (CLCVP) in laparoscopic hepatic lobectomy.
Methods: The clinical data of 97 patients undergoing laparoscopic hepatic lobectomy in the First Affiliated Hospital of Zhengzhou University from September 2013 to July 2017 were retrospectively analyzed. Of the patients, CLCVP was applied in 53 cases (CLCVP group) and not used in 44 cases (control group). Patients in both groups were further divided into simple laparoscopic hepatic lobectomy subgroup (left lateral lobectomy or irregular marginal lobectomy) and complex laparoscopic hepatic lobectomy subgroup (left hemihepatectomy, right hemihepatectomy, or mesohepatectomy). The main clinical variables were compared between the two groups and their subgroups.
Results: Operations were successfully performed in all patients and no perioperative death occurred. Either in whole or subgroup comparison, the intraoperative urine output and liver and renal function parameters showed no significant difference between patients in CLCVP group and control group (all P>0.05). In whole comparison, the hepatic resection time and length of postoperative hospital stay showed no significant difference between the two groups (both P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in CLCVP group were significantly less than those in control group (all P<0.05); in subgroup comparison, all above variables showed no significant difference in patients undergoing simple laparoscopic hepatic lobectomy between the two groups (all P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in patients undergoing complex laparoscopic hepatic lobectomy in CLCVP group were significantly reduced compared with their counterparts in control group (all P<0.05). The complications above Clavien-Dindo grade III occurred in 6 patients in CLCVP group and 5 patients in control group respectively (P>0.05); no symptomic pulmonary embolism occurred in any of the patients during or after surgery.
Conclusion: For patients undergoing complex laparoscopic hepatic lobectomy, using CLCVP can effectively reduce the amount of intraoperative blood loss and blood transfusion, and with no increase of risk for pulmonary embolism.
Keywords：
Hepatectomy; Laparoscopes; Central Venous Pressure; Hypotension
Controlled
Methods: The clinical data of 97 patients undergoing laparoscopic hepatic lobectomy in the First Affiliated Hospital of Zhengzhou University from September 2013 to July 2017 were retrospectively analyzed. Of the patients, CLCVP was applied in 53 cases (CLCVP group) and not used in 44 cases (control group). Patients in both groups were further divided into simple laparoscopic hepatic lobectomy subgroup (left lateral lobectomy or irregular marginal lobectomy) and complex laparoscopic hepatic lobectomy subgroup (left hemihepatectomy, right hemihepatectomy, or mesohepatectomy). The main clinical variables were compared between the two groups and their subgroups.
Results: Operations were successfully performed in all patients and no perioperative death occurred. Either in whole or subgroup comparison, the intraoperative urine output and liver and renal function parameters showed no significant difference between patients in CLCVP group and control group (all P>0.05). In whole comparison, the hepatic resection time and length of postoperative hospital stay showed no significant difference between the two groups (both P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in CLCVP group were significantly less than those in control group (all P<0.05); in subgroup comparison, all above variables showed no significant difference in patients undergoing simple laparoscopic hepatic lobectomy between the two groups (all P>0.05), but the intraoperative blood loss, number of cases requiring blood transfusion and amount of blood transfusion in patients undergoing complex laparoscopic hepatic lobectomy in CLCVP group were significantly reduced compared with their counterparts in control group (all P<0.05). The complications above Clavien-Dindo grade III occurred in 6 patients in CLCVP group and 5 patients in control group respectively (P>0.05); no symptomic pulmonary embolism occurred in any of the patients during or after surgery.
Conclusion: For patients undergoing complex laparoscopic hepatic lobectomy, using CLCVP can effectively reduce the amount of intraoperative blood loss and blood transfusion, and with no increase of risk for pulmonary embolism.