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.