中国实用外科杂志

中国实用外科杂志

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腹腔镜捆绑式肝局部血流阻断技术与Pringle法随机对照研究

张登明，甄作均，陈焕伟，王峰杰，计    勇，陈应军，李清汉   

  1. 佛山市第一人民医院肝胆外科，广东佛山528000
  • 发布日期:2012-09-28

  • Published:2012-09-28

摘要：

目的    通过捆绑式阻断法与Pringle法对比，探讨捆绑式肝局部血流阻断法在腹腔镜肝切除术中的可行性。 方法    2003年1月至2011年1月佛山市第一人民医院肝胆外科将收治的62例行腹腔镜肝肿瘤切除术的病人随机分为Pringle组（30例）与捆绑式阻断组（32例），对比分析两组在术中出血量、术前与术后肝功能变化、局部及全身并发症发生率、手术时间、住院时间的差异。 结果    两组术中出血量、围手术期并发症发生率、术前及术后1、3、7 d白蛋白（ALB）、总胆红素（TBIL）比较，差异无统计学意义（P>0.05）。捆绑式阻断组术前及术后1、3、7 d丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）比较差异有统计学意义（P<0.05）。两组住院时间比较，捆绑式阻断组明显低于Pringle组（P<0.05）。 结论    捆绑式阻断法止血效果确切，对肝功能的损害轻，术后恢复快，缩短住院时间，是一种安全、可靠、可行的血流阻断方法。

关键词: 腹腔镜, 肝功能, 血流阻断技术

Abstract:

Laparoscopic hepatectomy: Pringle maneuver versus tourniquet method        ZHANG Deng-ming, ZHEN Zuo-jun, CHEN Huan-wei, et al. Department of Hepatobiliary Surgery, the First People's Hospital of Foshan City, Foshan 528000, China
Corresponding author：ZHEN Zuo-jun，E-mail：zzjun@fsyyy.com
Abstract    Objective    To evaluate the feasibility of tourniquet method in laparoscopic hepatectomy compared with Pringle maneuver. Methods    Sixty-two patients performed laparoscopic hepatectomy between January 2003 and January 2011 in the Department of General Surgery, the First People’s Hospital of Foshan City were divided into Pringle group (30 patients) and tourniquet group (32 patients) randomly. The changes of preoperative and postoperative liver function, intraoperative blood loss, complications, operation time and hospital stay between the two groups were compared. Results    No significant difference was found in operative blood loss, perioperative complications, the TBIL and ALB before operation and on the first, third and seventh day after operation between two groups (P>0.05). There was significant difference in ALT and AST before operation and on the first, third and seventh day after operation between two groups (P＜0.05). Patients in tourniquet group had significantly faster recovery of liver function than those in Pringle group (P＜0.05). The postoperative hospital stay of tourniquet group was significantly shorter than that of Pringle group (P＜0.05). Conclusion    Tourniquet method can limit operative blood loss effectively with quicker recovery and shorter hospital stay, which is safe, efficient and feasible for patients performed laparoscopic hepatectomy.

Key words: laparoscope, liver function, vascular control