Effect of hemihepatic transhepatic occlusion combined with CLCVP on tissue perfusion and hepatorenal function of patients undergoing laparoscopic hepatectomy

doi:10.3877/cma.j.issn.1674-3946.2022.04.021

Abstract

Abstract:

Objective

To investigate the effects of hemihepatic blood flow occlusion combined with controlled low central venous pressure（CLCVP）on hepatic tissue perfusion and hepatorenal function in patients undergoing laparoscopic hepatectomy.

Methods

Data of 100 patients undergoing laparoscopic hepatectomy from June 2018 to December 2020 were retrospectively analyzed. They were divided into two groups according to whether CLCVP was combined with intraoperative hepatectomy，with 50 patients in CLCVP group and 50 patients in control group. Statistical software SPSS 24.0 was used for clinical data analysis. Perioperative indicators，intraoperative hemodynamics，intraoperative lactic acid level，liver and kidney function before and after surgery were expressed by（

x ˉ

±s），and independent t test was used. Statistical data were tested by χ² test. P<0.05 was considered as statistically significant difference.

Results

The operative time，intraoperative blood loss，hilar occlusion time and intraoperative blood transfusion cases in CLCVP group were all shorter than those in control group（P<0.05）. Before and 5 min after liver dissection，the central venous pressure（CVP）and mean arterial pressure（MAP）in CLCVP group were significantly lower than those in control group（P<0.05）. After hilar occlusion and liver dissection，the lactic acid level in both groups was significantly higher than that in the previous time point，and that in CLCVP group was significantly higher than that in the control group（P<0.05）. 1 d after surgery，ALT，AST，TBIL，Scr and BUN in 2 groups were significantly higher than before（P<0.05）.

Conclusion

The application of CLCVP after hemihepatic blood inflow occlusion can effectively control the amount of blood loss，shorten the operation time and reduce the rate of blood transfusion in laparoscopic hepatectomy. Although it may increase the intraoperative lactic acid level，it has no obvious effect on the liver and kidney function.

Key words: Hepatectomy, Laparoscopes, Hemihepatic blood inflow occlusion, Controlled low central venous pressure, Tissue perfusion, Liver and kidney function

Huanju Kang, Su Cao, Jingchun Wang, Lei Wang, Xue Liu. Effect of hemihepatic transhepatic occlusion combined with CLCVP on tissue perfusion and hepatorenal function of patients undergoing laparoscopic hepatectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(04): 427-430.

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Figures/Tables 5

References 18

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组别	例	年龄(岁)	BMI(kg/m²)	性别
组别	例	年龄(岁)	BMI(kg/m²)	男/女
CLCVP组	50	52.1±6.8	21.5±1.9	31/19
对照组	50	51.4±7.0	22.0±2.0	29/21
χ²/t/Z		0.507	1.281	0.166
P		0.306	0.101	0.683
组别	例	Child分级	ASA分级	切除肝段数目
组别	例	A/B	Ⅰ/Ⅱ	1/2/3/4
CLCVP组	50	35/15	42/8	9/16/15/10
对照组	50	39/11	44/6	10/13/19/8
χ²/t/Z		0.831	0.332	1.055
P		0.361	0.564	0.787

组别	例	年龄(岁)	BMI(kg/m²)	性别
组别	例	年龄(岁)	BMI(kg/m²)	男/女
CLCVP组	50	52.1±6.8	21.5±1.9	31/19
对照组	50	51.4±7.0	22.0±2.0	29/21
χ²/t/Z		0.507	1.281	0.166
P		0.306	0.101	0.683
组别	例	Child分级	ASA分级	切除肝段数目
组别	例	A/B	Ⅰ/Ⅱ	1/2/3/4
CLCVP组	50	35/15	42/8	9/16/15/10
对照组	50	39/11	44/6	10/13/19/8
χ²/t/Z		0.831	0.332	1.055
P		0.361	0.564	0.787

组别	例	手术时间 (min)	术中出血量 (ml)	肝门阻断时间 (min)
CLCVP组	50	162.3±24.8	188.4±23.7	25.2±7.6
对照组	50	194.7±26.4	263.6±39.5	27.9±7.9
χ²/t		6.325	11.543	1.741
P		0.000	0.000	0.042
组别	例	术中输血 (例)	引流管拔管时间 (d)	术后住院时间 (d)
CLCVP组	50	2	3.1±0.6	8.4±1.6
对照组	50	8	3.3±0.7	8.8±1.5
χ²/t		4.000	1.533	1.289
P		0.045	0.064	0.100

组别	例	手术时间 (min)	术中出血量 (ml)	肝门阻断时间 (min)
CLCVP组	50	162.3±24.8	188.4±23.7	25.2±7.6
对照组	50	194.7±26.4	263.6±39.5	27.9±7.9
χ²/t		6.325	11.543	1.741
P		0.000	0.000	0.042
组别	例	术中输血 (例)	引流管拔管时间 (d)	术后住院时间 (d)
CLCVP组	50	2	3.1±0.6	8.4±1.6
对照组	50	8	3.3±0.7	8.8±1.5
χ²/t		4.000	1.533	1.289
P		0.045	0.064	0.100

组别	例	时间	CVP (cmH₂O)	HR (次/min)	MAP (mmHg)
CLCVP组	50	麻醉诱导前	8.2±1.8	74.2±8.5	80.2±7.6
		肝脏离断前	3.8±1.1^b	68.6±7.1	66.4±6.0^b
		肝脏离断后 5 min	5.2±1.4^b	72.1±7.3	64.0±6.1^b
		手术结束前	6.6±1.5	78.4±8.2	76.4±7.3
对照组	50	麻醉诱导前	8.4±1.9	75.7±8.3	81.0±7.5
		肝脏离断前	8.5±2.1^a	69.2±7.3	73.3±6.5^a
		肝脏离断后 5 min	6.8±1.5^a	73.3±7.5	69.2±6.7^a
		手术结束前	6.9±1.8	79.1±8.5	78.7±7.9

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