肝下下腔静脉阻断与控制性低中心静脉压在复杂肝切除术 中应用的比较
| 作者: |
1姚豫桐,
1黄孝伦,
1罗兰云,
1薛华,
1骆乐,
1向光明,
1赖春友
1 四川省医学科学院/ 四川省人民医院 肝胆胰外科中心/ 细胞移植中心，四川 成都 610072 |
| 通讯: |
黄孝伦
Email: garrymd@163.com |
| DOI: | 10.3978/.2018.07.012 |
| 基金: | 四川省卫计委科研课题资助项目（16PJ431）；四川省医学科学院/ 四川省人民医院青年基金资助项目（2015QN01）。 |
摘要
目的：比较肝下下腔静脉（IIVC）阻断与控制性低中心静脉压（CLCVP）技术在复杂肝切除术中应用的安全性及有效性。
方法：回顾性分析 2016 年 3 月—2017 年 12 月行复杂肝切除术的 103 例原发性肝癌患者临床资料，术中所有患者均采用 Pringle 法控制入肝血流，其中 56 例行 IIVC 阻断（IIVC 阻断组），47 例行 CLCVP技术（CLCVP 组）降低中心静脉压（CVP）。比较两组切肝过程中 CVP 的变化、切肝过程出血量、手术总出血量、术中尿量、输血率、术后并发症发生率、术后肝功能与肾功能变化。
结果： 两组患者一般资料差异无统计学意义（均 P>0.05）。与切肝前对比，两组患者在切肝过程中CVP 均明显下降，但 IIVC 阻断组 CVP 较 CLCVP 降低更明显，且 IIVC 阻断组切肝过程中出血量、手术总出血量、术后第 3 天 ALT 和术后第 3、7 天 TBIL 均明显低于 CLCVP 组（均 P<0.05）。两组患者术中尿量、输血率及术后并发症发生率、肾功能情况差异无统计学意义（均 P>0.05）。
结论：IIVC 阻断联合 Pringle 法操作简单方便，相对于 CLCVP 技术，其对全身血流动力学影响较小，肝功能恢复更快，且更容易降低 CVP，减少术中肝脏断面出血，有利于提高复杂肝切除术的安全性。
关键词：
肝切除术；止血技术；中心静脉压；腔静脉，下
方法：回顾性分析 2016 年 3 月—2017 年 12 月行复杂肝切除术的 103 例原发性肝癌患者临床资料，术中所有患者均采用 Pringle 法控制入肝血流，其中 56 例行 IIVC 阻断（IIVC 阻断组），47 例行 CLCVP技术（CLCVP 组）降低中心静脉压（CVP）。比较两组切肝过程中 CVP 的变化、切肝过程出血量、手术总出血量、术中尿量、输血率、术后并发症发生率、术后肝功能与肾功能变化。
结果： 两组患者一般资料差异无统计学意义（均 P>0.05）。与切肝前对比，两组患者在切肝过程中CVP 均明显下降，但 IIVC 阻断组 CVP 较 CLCVP 降低更明显，且 IIVC 阻断组切肝过程中出血量、手术总出血量、术后第 3 天 ALT 和术后第 3、7 天 TBIL 均明显低于 CLCVP 组（均 P<0.05）。两组患者术中尿量、输血率及术后并发症发生率、肾功能情况差异无统计学意义（均 P>0.05）。
结论：IIVC 阻断联合 Pringle 法操作简单方便，相对于 CLCVP 技术，其对全身血流动力学影响较小，肝功能恢复更快，且更容易降低 CVP，减少术中肝脏断面出血，有利于提高复杂肝切除术的安全性。
Comparison of using infrahepatic inferior vena cava clamping versus controlled low central venous pressure in complex hepatectomy
CorrespondingAuthor:Xiaolun HUANG Email: garrymd@163.com
Abstract
Objective: To compare the safety and efficacy of using infrahepatic inferior vena cava (IIVC) clamping and controlled low central venous pressure (CLCVP) technique in complex hepatectomy.
Methods: The clinical data of 103 patients with hepatocellular carcinoma undergoing complex hepatectomy between March 2016 and December 2017 were retrospectively analyzed. Pringle maneuver was used for hepatic inflow control in all patients, of whom, 56 cases underwent IIVC clamping (IIVC clamping group) and 47 cases underwent CLCVP (CLCVP group) for reducing the central venous pressure (CVP). The changes of CVP and blood loss during parenchymal transection, total intraoperative blood loss, intraoperative urine volume, rate of blood transfusion and incidence of postoperative complications, as well as postoperative liver and renal functions between the two groups of patients were compared.
Results: The general data showed no significant differences between the two groups of patients (all P>0.05). The CVP levels in both groups were decreased significantly during parenchymal transection, but the decreasing amplitude in IIVC clamping group was greater than that in CLCVP group, and blood loss during parenchymal transection, the total intraoperative blood loss, ALT level on postoperative day (POD) 3 and TBIL level on POD 3 and 7 in IIVC clamping group were significantly lower than those in CLCVP group (all P<0.05). There were no significant differences in intraoperative urine volume, blood transfusion rate, incidence of postoperative complications and renal function parameters between the two groups (all P>0.05).
Conclusion: The operation of IIVC clamping combined with Pringle maneuver is simple and convenient, and it has advantages of less influence on systemic hemodynamics, faster recovery of liver function and easier CVP reduction for controlling bleeding in the cutting surface of the liver compared with CLCVP. So this method is helpful for improving the safety of complex hepatectomy.
Keywords：
Hepatectomy; Hemostatic Techniques; Central Venous Pressure; Vena Cava
Inferior
Methods: The clinical data of 103 patients with hepatocellular carcinoma undergoing complex hepatectomy between March 2016 and December 2017 were retrospectively analyzed. Pringle maneuver was used for hepatic inflow control in all patients, of whom, 56 cases underwent IIVC clamping (IIVC clamping group) and 47 cases underwent CLCVP (CLCVP group) for reducing the central venous pressure (CVP). The changes of CVP and blood loss during parenchymal transection, total intraoperative blood loss, intraoperative urine volume, rate of blood transfusion and incidence of postoperative complications, as well as postoperative liver and renal functions between the two groups of patients were compared.
Results: The general data showed no significant differences between the two groups of patients (all P>0.05). The CVP levels in both groups were decreased significantly during parenchymal transection, but the decreasing amplitude in IIVC clamping group was greater than that in CLCVP group, and blood loss during parenchymal transection, the total intraoperative blood loss, ALT level on postoperative day (POD) 3 and TBIL level on POD 3 and 7 in IIVC clamping group were significantly lower than those in CLCVP group (all P<0.05). There were no significant differences in intraoperative urine volume, blood transfusion rate, incidence of postoperative complications and renal function parameters between the two groups (all P>0.05).
Conclusion: The operation of IIVC clamping combined with Pringle maneuver is simple and convenient, and it has advantages of less influence on systemic hemodynamics, faster recovery of liver function and easier CVP reduction for controlling bleeding in the cutting surface of the liver compared with CLCVP. So this method is helpful for improving the safety of complex hepatectomy.