中国实用外科杂志

中国实用外科杂志

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腹腔镜肝切除术中肝下下腔静脉部分阻断对中心静脉压和出血量影响研究

商阳阳，肖林康，谢    炜，龚    毅   

  1. 中国科学院大学重庆医院肝胆外科，重庆 401147
  • 出版日期:2021-07-01 发布日期:2021-07-12

  • Online:2021-07-01 Published:2021-07-12

摘要： 目的    评估肝下下腔静脉部分阻断在腹腔镜肝切除术中的有效性和安全性。方法    回顾性分析2015年9月至2020年8月中国科学院大学重庆医院肝胆外科收治的行腹腔镜肝切除术的132例病人的临床资料。根据术中是否行肝下下腔静脉阻断分为阻断组（68例）和非阻断组（64例），分析术中出血量、中心静脉压、断肝时间、断肝面积等指标。结果    所有病人均能耐受肝下下腔静脉部分阻断；与非阻断组比，肝下下腔静脉阻断后无血流动力学不稳定且中心静脉压明显下降，差异有统计学意义［（4.4±1.6）cmH2O vs. （1.9±1.2）cmH2O，P＜0.05］。在出血量方面，阻断组总出血量和断肝出血量与非阻断组差异无统计学意义［（289.3±113.5）mL vs. （302.4±124.6）mL，（241.2±107.9）mL vs. （277.3±114.5）mL，P均＞0.05］；但在合并中重度肝硬化病人的亚组中，相较于非阻断组，阻断组中总失血量和断肝失血量明显减少，差异有统计学意义［（342.7±70.2）mL vs. （468.2±87.8）mL，（328.7±68.9）mL vs. （427.9±93.2）mL，P均＜0.05］。两组手术时间、断肝手术时间、肝断面面积、术中液体输注量以及术后肝肾功能比较差异均无统计学意义（P均＞0.05）。结论    腹腔镜肝切除术中行肝下下腔静脉阻断可减少中重度肝硬化病人术中出血量，且对肝肾功能无明显影响，安全有效。

关键词: 腹腔镜肝切除, 下腔静脉阻断, 肝硬化, 中心静脉压

Abstract: Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy        SHANG Yang-yang，XIAO Lin-kang，XIE Wei，et al. Department of Hepatobiliary Surgery，Chongqing People’s Hospital，University of Chinese Academy of Sciences，Chongqing 401147，China
Corresponding author：GONG Yi，E-mail：kongyee_183@163.com
Abstract    Objective    To evaluated the efficacy and safety of infrahepatic inferior vena cava （IVC）clamping during laparoscopic hepatectomy（LH）. Methods    A total of 132 patients scheduled for LH in the department of hepatobiliary surgery of Chonging People's Hospital from September 2015 to August 2020 were retrospectively reviewed. They were divided two groups: Infrahepatic IVC clamping group and Non-clamping group. The intraoperative blood loss，central venous pressure，operative time and transection surface area were analyzed. Results    All patients in the infrahepatic IVC clamping group were able to tolerate partial clamping of IVC. The CVP was significantly decreased after infrahepatic IVC clamping without hemodynamic instability［（4.4±1.6）cmH2O vs. （1.9±1.2）cmH2O，P＜0.05］. Infrahepatic IVC clamping did not significantly reduce total blood loss ［（289.3±113.5）mL vs. （302.4±124.6）mL，P＞0.05］ and blood loss during parenchymal transection［（241.2±107.9）mL vs. （277.3±114.5）mL，P＞0.05］ compared with the non-clamping group. In subgroup analysis，total blood loss and blood loss during parenchymal transection were significantly reduced in patients with moderate to severe cirrhosis in the clamping group［（342.7±70.2）mL vs. （468.2±87.8）mL，（328.7±68.9）mL vs. （427.9±93.2）mL，P<0.05］. There were no significant differences between the two groups in operation time，operation time of severed liver，liver cross-section area，intraoperative liquid infusion volume and postoperative liver and kidney function (P＞0.05). Conclusion    Infrahepatic IVC clamping can reduce intraoperative blood loss in patients with moderate and severe cirrhosis，it has no significant effect on liver and kidney function，which is safe and effective.

Key words: laparoscopic hepatectomy, infrahepatic inferior vena cava clamping, cirrhosis, central venous pressure