简化腔内Pringle法与传统Pringle法在腹腔镜肝切除术中安全性及有效性前瞻性对比研究

doi:10.3877/cma.j.issn.1674-3946.2021.02.020

目的

比较简化腔内Pringle法与传统Pringle法在腹腔镜肝切除术中安全性及有效性。

方法

选择2018年1月至2019年6月行腹腔镜肝切除术的80例患者进行前瞻性研究。按照随机数表法将患者分为简化组(简化腔内Pringle法)和传统组(传统Pringle法)各40例。采用SPSS 20.0软件对数据进行处理，围术期各项指标等计量资料以(±s)表示，采用独立样本t检验；术后并发症等计数资料比较采用χ²检验；P<0.05为差异有统计学意义。

结果

两组患者手术时间、腹腔引流量、术中出血量、肝门阻断时间及住院时间差异无统计学意义(P>0.05)。两组患者术后7 d ALT、AST、ALB、TBIL水平相较于术前均明显接近正常(P<0.05)；术后7 d简化组ALT、ALB水平均明显高于传统组(P<0.05)；术后7 d两组间AST、TBIL水平比较差异无统计学意义(P>0.05)。简化组术后并发症总发生率12.5%低于传统组术后并发症总发生率为20.0%，但差异无统计学意义(P>0.05)。

结论

简化腔内Pringle法与传统腔外Pringle法均可有效阻断入肝血流，但简化腔内Pringle法可降低肝功能损害程度，在减少腹壁创伤方面有一定的优势。

关键词: 肝切除术, 腹腔镜, 疗效比较研究, 全入肝血流阻断法, 血流阻断

Objective

To Analyze and compare the safety and effectiveness of simplified intra-cavity Pringle method and traditional Pringle method in laparoscopic hepatectomy.

Methods

A prospective study was performed in 80 patients underwent laparoscopic hepatectomy in our general surgery department from January 2018 to June 2019. According to the random number table method, patients were divided into simplified group (by using simplified intra-cavity Pringle method, 40 cases) and control group (by using traditional Pringle method, 40 cases). Statistical analysis were performed by using SPSS 20.0 software. Perioperative indicators and other measurement data were expressed as (±s), and examined by using independent sample t-test. Postoperative complications were compared by using the χ² test; A P value of <0.05 was considered as statistically significant difference.

Results

There were no statistically significant differences between the two groups in terms of operation time, abdominal drainage volume, intraoperative blood loss, portal clamping time and hospital stay time (P>0.05). The levels of ALT, AST, ALB, and TBIL in both groups were significantly decreased to be normal 7 days after operation (P<0.05); The level of ALT and ALB in the simplified group were significantly higher than those in the traditional group 7 days after operation (P<0.05); There were no significant differences between the two groups in terms of AST and TBIL levels 7 days after operation (P>0.05). Total postoperative complications incidence of 12.5% in the simplified group was lower than 20.0% in the traditional group, without statistically significant difference (P>0.05).

Conclusion

Both the simplified intra-cavity Pringle method and the traditional extra-cavity Pringle method could effectively block blood flow within the liver, however the simplified intra-cavity Pringle method could reduce the degree of liver function damage and has certain advantages in reducing abdominal wall trauma.

Key words: Hepatectomy, Laparoscopes, Comparative effectiveness research, Total hepatic blood flow occlusion, Blockage of blood flow

表1 80例腹腔镜肝切除术不同术式两组患者一般基线资料比较[(±s)，例]

组别	例数	年龄(岁)	BMI (kg/m²)	性别	上腹部手术史
组别	例数	年龄(岁)	BMI (kg/m²)	男/女	上腹部手术史
简化组	40	59.1±10.4	24.1±3.8	28/12	5
对照组	40	57.9±10.6	24.2±3.6	30/10	3
t/χ²		0.511	0.121	0.251	0.556
P		0.611	0.904	0.617	0.456
组别	例数	肿瘤直径(cm)	Child-Pugh	ASA分级
组别	例数	肿瘤直径(cm)	A/B	1/2/3
简化组	40	5.7±1.6	36/4	8/29/3
对照组	40	5.5±1.3	34/6	15/22/3
t/χ²		0.614	0.457	3.091
P		0.541	0.499	0.213

表1 80例腹腔镜肝切除术不同术式两组患者一般基线资料比较[(±s)，例]

组别	例数	年龄(岁)	BMI (kg/m²)	性别	上腹部手术史
组别	例数	年龄(岁)	BMI (kg/m²)	男/女	上腹部手术史
简化组	40	59.1±10.4	24.1±3.8	28/12	5
对照组	40	57.9±10.6	24.2±3.6	30/10	3
t/χ²		0.511	0.121	0.251	0.556
P		0.611	0.904	0.617	0.456
组别	例数	肿瘤直径(cm)	Child-Pugh	ASA分级
组别	例数	肿瘤直径(cm)	A/B	1/2/3
简化组	40	5.7±1.6	36/4	8/29/3
对照组	40	5.5±1.3	34/6	15/22/3
t/χ²		0.614	0.457	3.091
P		0.541	0.499	0.213

表2 80例腹腔镜肝切除术不同术式两组患者围术期指标比较(±s)

组别	例数	手术时间(min)	腹腔引流量(ml)	术中出血量(ml)
简化组	40	204.7±39.8	338.0±29.1	417.5±80.4
传统组	40	219.2±45.4	330.2±28.8	396.3±96.1
t		1.519	1.205	1.070
P		0.133	0.232	0.288
组别	例数	肝门阻断时间(min)	住院时间(min)
简化组	40	32.1±7.6	12.8±3.3
传统组	40	31.6±7.5	11.9±2.9
t		0.296	1.296
P		0.768	0.199

表2 80例腹腔镜肝切除术不同术式两组患者围术期指标比较(±s)

组别	例数	手术时间(min)	腹腔引流量(ml)	术中出血量(ml)
简化组	40	204.7±39.8	338.0±29.1	417.5±80.4
传统组	40	219.2±45.4	330.2±28.8	396.3±96.1
t		1.519	1.205	1.070
P		0.133	0.232	0.288
组别	例数	肝门阻断时间(min)	住院时间(min)
简化组	40	32.1±7.6	12.8±3.3
传统组	40	31.6±7.5	11.9±2.9
t		0.296	1.296
P		0.768	0.199

表3 80例腹腔镜肝切除术不同术式两组患者术前、术后7 d肝功能指标比较(±s)

组别	时间	ALT(U/L)	AST(U/L)
简化组	术前	81.8±14.4	50.1±13.5
简化组	术后7 d	44.1±17.6^ab	31.6±10.6^b
传统组	术前	78.5±13.2	50.9±12.5
传统组	术后7 d	35.3±19.1^b	34.5±13.7^b
组别	时间	ALB(g/L)	TBIL(μmol/L)
简化组	术前	21.6±4.9	45.0±4.8
简化组	术后7 d	39.5±16.4^ab	18.2±4.9^b
传统组	术前	21.9±5.3	43.8±4.4
传统组	术后7 d	31.6±14.8^b	17.2±5.5^b

表3 80例腹腔镜肝切除术不同术式两组患者术前、术后7 d肝功能指标比较(±s)

组别	时间	ALT(U/L)	AST(U/L)
简化组	术前	81.8±14.4	50.1±13.5
简化组	术后7 d	44.1±17.6^ab	31.6±10.6^b
传统组	术前	78.5±13.2	50.9±12.5
传统组	术后7 d	35.3±19.1^b	34.5±13.7^b
组别	时间	ALB(g/L)	TBIL(μmol/L)
简化组	术前	21.6±4.9	45.0±4.8
简化组	术后7 d	39.5±16.4^ab	18.2±4.9^b
传统组	术前	21.9±5.3	43.8±4.4
传统组	术后7 d	31.6±14.8^b	17.2±5.5^b

表4 80例腹腔镜肝切除术不同术式两组患者术后并发症发生率比较(例)

组别	例数	胸腔积液	腹水	肺部感染	胆瘘	总发生率(%)
简化组	40	1	1	2	1	5(12.5)
传统组	40	2	2	3	1	8(20.0)
χ²						0.826
P						0.363

表4 80例腹腔镜肝切除术不同术式两组患者术后并发症发生率比较(例)

组别	例数	胸腔积液	腹水	肺部感染	胆瘘	总发生率(%)
简化组	40	1	1	2	1	5(12.5)
传统组	40	2	2	3	1	8(20.0)
χ²						0.826
P						0.363

[1]	Fretland AA, Dagenborg VJ, Bjornelv GMW, et al. Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial[J]. Ann Surg, 2018, 267(2): 199-207.
[2]	Gupta R, Fuks D, Bourdeaux C, et al. Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection[J]. Surg Endosc, 2017, 31(11): 4451-4457.
[3]	张能平，张雄杰．不同肝血流阻断方式在肝癌患者腹腔镜肝切除术中的应用[J/CD]．中国肝脏病杂志(电子版)，2019，11(03)：58-63.
[4]	Huang J-W, Su W-L, Wang S-N. Alternative Laparoscopic Intracorporeal Pringle Maneuver by Huang's Loop[J]. World J Surg, 2018, 42(10): 3312-3315.
[5]	冶俊山，魏永刚，蓝翔，等. 腹腔镜入肝血流阻断方案对肝细胞癌合并肝硬变患者肝切除的安全性对比[J]. 中国普外基础与临床杂志，2019，26(2)：141-147.
[6]	梁霄，蒋桂星．腹腔镜肝切除的优势与关键技术[J]．肝胆外科杂志，2019，27(4)：241-243.
[7]	Cheung TT, Ma KW, She WH, et al. Pure laparoscopic hepatectomy with augmented reality-assisted indocyanine green fluorescence versus open hepatectomy for hepatocellular carcinoma with liver cirrhosis: A propensity analysis at a single center[J]. Asian J Endosc Surg, 2018, 11(2): 104-111.
[8]	Kasai M, Cipriani F, Gayet B, et al.Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data[J]. Surgery, 2018, 163(5): 985-995.
[9]	王传喜，胡明华，王小明，等．腹腔镜肝脏手术中转开腹原因分析[J]．齐齐哈尔医学院学报，2019，40(11)：1384-1386.
[10]	Liu XH, Min XC, Ma Z, et al. Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: An updated systematic review and meta-analysis[J]. Int J Surg, 2018, 51: 151-163.
[11]	Halls MC, Cipriani F, Berardi G, et al. Conversion for Unfavorable Intraoperative Events Results in Significantly Worst Outcomes During Laparoscopic Liver Resection: Lessons Learned From a Multicenter Review of 2861 Cases[J]. Ann Surg, 2017, 268(6): 1051-1057.
[12]	Stiles ZE, Behrman SW, Glazer ES, et al. Predictors and implications of unplanned conversion during minimally invasive hepatectomy: an analysis of the ACS-NSQIP database[J]. HPB, 2017, 19(11): 957-965.
[13]	Stiles ZE, Glazer ES, Deneve JL, et al. Long-Term Implications of Unplanned Conversion During Laparoscopic Liver Resection for Hepatocellular Carcinoma[J]. Ann Surg Oncol, 2018, 26(1): 282-289.
[14]	Laurenzi A, Cherqui D, Figueroa R, et al. Totally intra-corporeal Pringle maneuver during laparoscopic liver resection[J]. HPB, 2018, 20(2): 128-131.
[15]	Zhang WG, Wang J, Li CH, et al. Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas[J]. Surg Endosc, 2017, 31(9): 3628-3636.

[1]	代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[2]	李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3]	曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[4]	杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[5]	周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[6]	张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[7]	王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[8]	李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[9]	甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[10]	逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[11]	易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[12]	莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[13]	鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[14]	孟飞龙, 华帅, 张莹, 路广海. 经脐单孔腹腔镜后鞘后入路在全腹膜外腹股沟疝修补术中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 658-660.
[15]	阿冲罗布, 陈颖, 谢德坤. 腹腔镜外囊完整剥离术治疗肝包虫病效果及对患者肝功能、预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 666-669.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Prospective comparative study on the safety and effectiveness of simplified intra-cavity Pringle method and traditional Pringle method in laparoscopic hepatectomy

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Prospective comparative study on the safety and effectiveness of simplified intra-cavity Pringle method and traditional Pringle method in laparoscopic hepatectomy