切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 376 -379. doi: 10.3877/cma.j.issn.1674-3946.2025.04.008.

论著

腹腔镜下不同入肝血流阻断肝切除治疗原发性肝癌的近中期随访比较
张光亚1, 方荣喜1, 吴鹏1, 肖虎1,()   
  1. 1. 725000 陕西安康,安康市中心医院普外科
  • 收稿日期:2024-12-18 出版日期:2025-08-26
  • 通信作者: 肖虎
  • 基金资助:
    陕西省科学技术厅应用技术类科技项目(9612023Y1012)

Comparison of short-and medium-term follow-up of hepatectomy with different inflow blood flow occlusion of the liver under laparoscopy in the treatment of primary liver cancer

Guangya Zhang1, Rongxi Fang1, Peng Wu1, Hu Xiao1,()   

  1. 1. Department of General Surgery, Ankang Central Hospital, Ankang Shaanxi Province 725000, China
  • Received:2024-12-18 Published:2025-08-26
  • Corresponding author: Hu Xiao
引用本文:

张光亚, 方荣喜, 吴鹏, 肖虎. 腹腔镜下不同入肝血流阻断肝切除治疗原发性肝癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 376-379.

Guangya Zhang, Rongxi Fang, Peng Wu, Hu Xiao. Comparison of short-and medium-term follow-up of hepatectomy with different inflow blood flow occlusion of the liver under laparoscopy in the treatment of primary liver cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 376-379.

目的

对比腹腔镜下不同入肝血流阻断肝切除治疗原发性肝癌(PLC)的近中期疗效。

方法

收集2021年3月至2023年9月115例PLC腹腔镜下肝切除术患者临床资料,依据术中入肝血流阻断方式不同患者分为A组(间歇性血流阻断,n=57例)与B组(区域性血流阻断,n=58例),使用统计学软件SPSS 25.0处理数据,围手术期指标、肝功能指标、肿瘤标志物等以()表示,采用t检验。通过一般线性重复度量方差分析检验肝功能及肿瘤标志物水平;通过χ2检验比较术后并发症发生率。

结果

B组术中出血量少于A组(P<0.05);B组患者术后首次排气、进食及排便时间均短于A组(P<0.05)。术后7d,两组天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平较术前升高,但B组低于A组;两组胆碱酯酶(ChE)水平下降,但B组高于A组(P<0.05)。术后1个月,两组AST、ALT水平较术前、术后7d下降,ChE水平较术前、术后7d提升(P<0.05);术后1个月,A组与B组AST、ChE、ALT水平比较,差异无统计学意义(P>0.05)。术后1个月和术后12个月,两组甲胎蛋白(AFP)、癌胚抗原(CEA)水平均较术前降低(P<0.05),但术后1个月和术后12个月时,A组与B组AFP、CEA水平比较,差异无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。

结论

相较于间歇性入肝血流阻断法,在腹腔镜下肝切除术中应用区域性入肝血流阻断法能减少术中出血量,且对患者胃肠功能和肝功能影响较小,但两组方法安全性和对肿瘤学效果影响近似。

Objective

To compare the short- and medium-term curative effects of hepatectomy with different inflow blood flow occlusion of the liver under laparoscopy in the treatment of primary liver cancer (PLC).

Methods

The clinical data of 115 patients who underwent laparoscopic hepatectomy for PLC from March 2021 to September 2023 were collected. According to different methods of intraoperative inflow blood flow occlusion of the liver, the patients were divided into group A (intermittent blood flow occlusion, n=57 cases) and group B(regional blood flow occlusion, n=58 cases). The statistical software SPSS 25.0 was used for data processing.The perioperative indexes, liver function indexes, tumor markers, etc. were expressed as (), and a t test was used. The levels of liver function and tumor markers were examined by general linear repeated measures analysis of variance. The incidence of postoperative complications was compared by the chi-square test.

Results

The intraoperative blood loss in group B was less than that in group A (P<0.05). The time of the first exhaust, eating, and defecation after surgery in group B was shorter than that in group A (P<0.05). Seven days after surgery, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in both groups were higher than those before surgery, but the levels in group B were lower than those in group A. The levels of cholinesterase (ChE) in both groups decreased, but the levels in group B were higher than those in group A (P<0.05).One month after surgery, the levels of AST and ALT in both groups were lower than those before surgery and 7 days after surgery, and the level of ChE was higher than that before surgery and 7 days after surgery (P<0.05).One month after surgery, there was no statistically significant difference in the levels of AST, ChE, and ALT between group A and group B (P>0.05). One month and 12 months after surgery, the levels of alpha-fetoprotein(AFP) and carcinoembryonic antigen (CEA) in both groups were lower than those before surgery (P<0.05), but there was no statistically significant difference in the levels of AFP and CEA between group A and group B one month and 12 months after surgery (P>0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P>0.05).

Conclusion

Compared with the intermittent inflow blood flow occlusion method of the liver, the application of the regional inflow blood flow occlusion method of the liver in laparoscopic hepatectomy can reduce the intraoperative blood loss and has less impact on the gastrointestinal function and liver function of patients. However, the safety of the two methods and their impacts on the oncological effects are similar.

表1 腹腔镜下肝切除术不同入肝血流阻断方式两组患者基线资料比较
表2 腹腔镜下肝切除术不同入肝血流阻断方式两组患者围手术期指标对比(
表3 腹腔镜下肝切除术不同入肝血流阻断方式两组患者肝功能对比(
表4 腹腔镜下肝切除术不同入肝血流阻断方式两组患者肿瘤标志物对比(
表5 腹腔镜下肝切除术不同入肝血流阻断方式两组患者术后并发症对比 [例(%)]
[1]
Zhang X, Wang Z,Tang W, et al. Ultrasensitive and affordable assay for early detection of primary liver cancer using plasma cellfree DNA fragmentomics [J]. Hepatology,2022,76(2): 317-329.
[2]
Jiang C, Feng Q, Zhang Z, et al. Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis [J]. World J Surg Oncol,2024,22(1): 188.
[3]
Li HJ, Wang Q, Yang ZL, et al. Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: Systematic review and meta-analysis of propensity score-matched studies[J].Eur J Surg Oncol, 2023, 49(4): 700-708.
[4]
刘可峰,王伟,范永刚. 新型入肝血流阻断方式对肝癌手术患者的疗效及对其肝、胃肠功能指标及预后的影响[J]. 实用癌症杂志, 2022, 37(02): 266-269.
[5]
张安清,东爱华,李红霞,等. 三种肝血流阻断技术在腹腔镜下肝切除术中的对比研究[J/CD]. 中华普外科手术学杂志(电子版), 2022, 16(03): 323-326.
[6]
中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 中华肝脏病杂志, 2020, 28(02):112-128.
[7]
Anthony PP, Ishak KG, Nayak NC, et al. The morphology of cirrhosis: definition, nomenclature, and classification[J]. Bull World Health Organ, 1977, 55(4): 521-40.
[8]
徐竹林,兰春斌,胥彬,等. 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[J/CD]. 中华普外科手术学杂志(电子版), 2021, 15(02): 191-194.
[9]
王迁,王征征,王珣. 入肝血流不同处理方式对肝癌手术患者的疗效及对其不良反应的影响[J]. 实用癌症杂志, 2023,38(10): 1682-1684.
[10]
陈雪芳,熊子慧,叶青,等. 经Glisson鞘左、右半肝血流阻断法在腹腔镜解剖性肝中叶切除术中的应用[J]. 肝胆胰外科杂志, 2023, 35(01): 25-29.
[11]
袁维栋,赵何伟,周昂,等. Glisson鞘外血流阻断法在腹腔镜左半肝切除术中的应用效果观察[J]. 中国医刊, 2023, 58(06):639-642.
[12]
范明,杨龙,金亮,等. 不同入肝血流阻断技术下腹腔镜肝切除术治疗原发性肝癌患者近期效果研究[J]. 实用肝脏病杂志, 2024, 27(01): 101-104.
[13]
平胜,牟亚刚. 交替区域入肝血流阻断在原发性肝癌手术治疗中的应用效果及对患者肝功能,营养指标的影响[J]. 中国医药导刊, 2023, 25(10): 1035-1039.
[14]
常江,王勇,杨青壮. 不同肝血流阻断方式在腹腔镜左半肝切除术肝癌患者中的应用[J]. 长春中医药大学学报, 2024,40(06): 675-680.
[15]
陈燕,太云翔,张峰,等. 不同入肝血流阻断技术下腹腔镜肝切除术对原发性肝癌治疗效果的影响[J]. 川北医学院学报,2023, 38(08): 1106-1109.
[1] 唐健雄, 李绍杰. 我国腹腔镜疝外科治疗现状、问题与未来[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 355-358.
[2] 田文, 杨晓冬. 我国腹腔镜疝手术治疗难点与对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 359-361.
[3] 李涛, 朱含放, 李世拥. 我国腹腔镜疝修补术式选择与原则[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 362-365.
[4] 朱永慧, 桑迪, 张翠翠. 改良后腹膜优先原位LPD对壶腹部周围癌区域淋巴结清扫和并发症的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 372-375.
[5] 李涛, 朱含放, 李世拥. 腹腔镜下经腹腹膜前右侧腹股沟疝修补术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 366-366.
[6] 李凯, 母德安, 陈淋, 张志远, 张伟. 超微创钳辅助经脐单孔腹腔镜肝右前叶切除[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 367-367.
[7] 沈锋, 王葵, 刘建伟. 我国腹腔镜肝癌手术治疗现状、问题与发展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 237-240.
[8] 蔡建强, 毕新宇, 徐博文. 我国腹腔镜肝癌手术的难点与对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 241-244.
[9] 钱小梅, 罗洪, 李智慧, 周代君, 李东. 76例乙型肝炎肝硬化并发原发性肝癌的高危因素Logistic分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 251-253.
[10] 卢超, 陈波, 邢志祥, 周鹏, 王帅. 不同入路下腹腔镜解剖性肝脏切除术治疗肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 254-257.
[11] 盛海涛, 窦明睿, 王俊杰, 修小龙, 杨建茂, 董长城. 基于CT三维可视化技术的个体化肝分段在解剖性肝切除术中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 258-261.
[12] 汪志翔, 何战洋. 不同淋巴结清扫术在No.16淋巴结局限性转移的局部进展期胃癌中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 266-269.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜解剖性完全左半肝切除术治疗肝内胆管细胞癌[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 639-639.
[14] 母德安, 向涵, 苏怀东, 张伟. 张氏超微创器械辅助单孔腹腔镜左三叶肝切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 640-640.
[15] 焦振东, 金上博. 腹腔镜肝癌切除术治疗肝癌破裂出血[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 641-641.
阅读次数
全文


摘要