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中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 27 -31. doi: 10.3877/cma.j.issn.1674-0793.2021.01.006

所属专题: 文献

论著

交替性区域入肝血流阻断在肝癌合并肝硬化患者肝切除术中的临床效果
舒捷1,(), 姜丽芳1, 赵萍1   
  1. 1. 628000 四川省广元市中医医院手术室
  • 收稿日期:2020-07-02 出版日期:2021-02-01
  • 通信作者: 舒捷
  • 基金资助:
    四川省卫生健康委员会科研课题(19ZD011)

Clinical effect of alternate regional inflow into the liver for hepatectomy in patients with hepatocellular carcinoma and cirrhosis

Jie Shu1,(), Lifang Jiang1, Ping Zhao1   

  1. 1. Operating Room, Guangyuan Traditional Chinese Medicine Hospital, Guangyuan 628000, China
  • Received:2020-07-02 Published:2021-02-01
  • Corresponding author: Jie Shu
引用本文:

舒捷, 姜丽芳, 赵萍. 交替性区域入肝血流阻断在肝癌合并肝硬化患者肝切除术中的临床效果[J/OL]. 中华普通外科学文献(电子版), 2021, 15(01): 27-31.

Jie Shu, Lifang Jiang, Ping Zhao. Clinical effect of alternate regional inflow into the liver for hepatectomy in patients with hepatocellular carcinoma and cirrhosis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(01): 27-31.

目的

研究交替性区域入肝血流阻断在肝癌合并肝硬化患者肝切除术中的安全性,并评价临床应用效果。

方法

本研究为回顾性病例对照研究。选取2016年9月至2020年4月广元市中医医院收治的56例行肝切除术的肝癌合并肝硬化患者,根据入肝血流阻断方式的不同分为两组,其中交替阻断组(26例)采用交替性区域入肝血流阻断技术,传统阻断组(30例)采用区域血流阻断技术。分别统计两组患者围手术期指标,术前及术后第1、3、7天时的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、白三烯C4(LTC4)等指标变化情况,术后并发症发生情况。

结果

交替阻断组术中出血量显著少于传统阻断组,差异有统计学意义(P<0.05),其余围手术期指标比较差异均无统计学意义。两组患者术前ALT、AST、IL-6、TNF-α和LTC4水平差异均无统计学意义,术后水平均先升高随后逐渐减低,传统阻断组术后第1、3、7天时ALT、AST、IL-6、TNF-α和LTC4水平均高于同期交替阻断组,差异有统计学意义(P<0.05)。交替阻断组术后总并发症发生率低于传统阻断组,差异有统计学意义(P<0.05)。

结论

相比于Pringle法,肝癌合并肝硬化患者肝切除术中行交替性区域入肝血流阻断,能够减少术中出血及术后输血,减轻肝损伤,降低再灌注应激反应及并发症发生率,安全可行,更有利于患者术后恢复。

Objective

To investigate the safety and clinical efficacy of alternate region entry blood flow occlusion in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis.

Methods

This was a retrospective case-control study. From September 2016 to April 2020, 56 cases of liver cancer with liver cirrhosis from Guangyuan Traditional Chinese Medicine Hospital were selected. According to the different ways of blood flow blocking into the liver, they were divided into the alternating-block group (26 cases) and the traditional-block group (30 cases). The perioperative indicators of the two groups were counted respectively, including changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), leutriene C4 (LTC4) before and after operation on day 1, 3 and 7. The occurrence of postoperative complications were compared between the two groups.

Results

The intraoperative blood loss in the alternating-block group was significantly lower than that in the conventional block group, and the difference was statistically significant (P<0.05), while the other perioperative indicators showed no statistical significance. There were no statistically significant differences in ALT, AST, IL-6, TNF-α and LTC4 levels between the two groups before surgery, and the levels in the traditional-block group were all higher than those in the alternating-block group after the operation, with statistically significant differences (P<0.05). The incidence of postoperative complications in the alternating-block group was lower than that in the traditional-block group (P<0.05).

Conclusion

Compared with Pringle method, alternate regional blood flow blocking in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis can reduce intraoperative bleeding, alleviate liver injury, depress reperfusion stress reaction and incidence of complications, which is safe and feasible, and more conducive to postoperative recovery of patients.

表1 两组肝癌合并肝硬化患者一般资料比较
表2 两组肝癌合并肝硬化患者围手术期指标比较
表3 两组肝癌合并肝硬化患者手术前后肝功能指标比较(U/L, ±s)
表4 两组肝癌合并肝硬化患者手术前后IL-6、TNF-α、LTC4比较(±s)
[1]
张明媛,牛俊奇. 东方国家原发性肝癌发病趋势及影响因素[J]. 临床肝胆病杂志, 2018, 34(7): 1399-1402.
[2]
He J. Strengthen the cancer surveillance to promote cancer prevention and control in China[J]. Zhonghua Zhong Liu Za Zhi, 2018, 40(1): 1-4.
[3]
邓银田,韩亚飞,邱伟, 等. 肝癌切除术中选择性入肝血流阻断对肝脏缺血再灌注损伤的影响[J]. 海南医学院学报, 2016, 22(21): 2619-2621, 2624.
[4]
雷光林,李媛媛,王淑英, 等.鞘外区域血流阻断与全肝入肝血流阻断对肝癌合并肝硬化手术疗效的影响比较[J].胃肠病学和肝病学杂志, 2019, 28(12): 1350-1353.
[5]
周存才,荚卫东,周新文, 等. 肝脏血流分级阻断在肝切除术中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(2): 127-132.
[6]
Jia C, Dai C, Wang H, et al. Differential effects of three techniques for hepatic vascular exclusion during resection for liver cirrhosis on hepatic ischemia-reperfusion injury in rats[J]. Gastroenterol Res Pract, 2018, 2018: 5309286.
[8]
赵西太,聂青和. 生物信息学方法筛选原发性肝癌早期诊断相关miRNA[J]. 胃肠病学和肝病学杂志, 2018, 27(6): 609-612.
Zhang Y, Yang H, Deng X, et al. Intermittent pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection[J]. Surg Endosc, 2016, 30(3): 961-970.
[9]
毛岸荣,潘奇,赵一鸣, 等. 三种肝血流阻断技术在原发性肝癌合并肝硬化肝切除的对比研究[J]. 肝脏, 2017, 22(2): 116-118.
[10]
虞洪,李哲勇,戴益. 区域血流阻断技术在腹腔镜肝右后叶切除术中的应用价值[J]. 中华消化外科杂志, 2018, 17(1): 104-108.
[11]
冯莉,王黎明,荣维淇, 等. 肝细胞癌切除术中区域血流预阻断与区域血流阻断的疗效对比初探[J]. 中华肿瘤杂志, 2015, (3): 186-189.
[12]
Li N, Hua J. Immune cells in liver regeneration[J]. Oncotarget, 2017, 8(2): 3628-3639.
[13]
Wei W, Jiang F, Liu XC, et al. TMEM9 mediates IL-6 and IL-1β secretion and is modulated by the Wnt pathway[J]. Int Immunopharmacol, 2018, 63: 253-260.
[14]
吉斐,华赟鹏,吴浩, 等. 缺血预处理减轻大鼠肝缺血再灌注损伤的免疫机制[J/CD]. 中华普通外科学文献(电子版), 2015, 9(4): 267-272.
[15]
文夏杰,姚明解,张玲, 等. 实验室常见检测指标对肝细胞癌预后预测价值的思考[J].临床肝胆病杂志, 2018, 34(7): 1395-1398.
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