不同肝血流阻断方式肝切除手术对原发性肝癌合并肝硬化患者肝功能及肠黏膜屏障的影响

目的:探讨肝切除手术运用Pringle法阻断、半肝血流阻断(HVC)后对原发性肝癌合并肝硬化患者肝功能及肠黏膜屏障的影响。方法:选取2016年4月～2019年9月期间我院收治的原发性肝癌合并肝硬化患者93例,根据随机数字表法将患者分为A组(n=46,Pringle法阻断)和B组(n=47,HVC),比较两组患者围术期指标、肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST)以及总胆红素(TBIL)]、肠黏膜屏障指标D-乳酸,内毒素]及并发症发生情况。结果:两组阻断时间、术中失血量、手术时间比较无差异(P0.05);B组住院时间短于A组(P0.05)。两组术前、术后3 d、术后7 d ALT、AST、TBIL呈升高后降低趋势,且B组低于A组(P0.05)。两组患者术后并发症发生率比较无差异(P0.05)。两组术前、术后3 d、术后7dD-乳酸、内毒素呈升高后降低趋势,且B组低于A组(P0.05)。结论:与Pringle法阻断相比,原发性肝癌合并肝硬化患者在肝切除手术中运用HVC,可有效缩短住院时间,减轻肝功能及肠黏膜屏障损害,且不增加并发症发生率,临床应用价值较高。

Effect of Hepatectomy with Different Hepatic Blood Flow Blocking Methods on Liver Function and Intestinal Mucosal Barrier in Patients with Primary Liver Cancer and Cirrhosis

ABSTRACT Objective: To investigate the effect of different hepatic blood flow blocking methods of hepatectomy on liver function and intestinal mucosal barrier in patients with primary liver cancer and cirrhosis. Methods: 93 patients with primary liver cancer and cirrhosis who were treated in our hospital from April 2016 to September 2019 were selected, they were divided into group A (n=46, Pringle method) and group B (n=47, HVC) according to the random number table method. Perioperative indexes, liver function indexes alanine aminotransferase (ALT), transglutaminase (AST), total bilirubin (TBIL)], intestinal mucosal barrier indexes D-lactate, endotoxin] and complications were compared between the two groups. Results: There was no significant difference in intraoperative block time, blood lossand operation time between the two groups(P>0.05), the hospitalization time of group B was shorter than that of group A (P<0.05). The ALT, AST and TBIL in the two groups were increased and decreased 3 d and 7 d after operation, and the level in group B was lower than that in group A (P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P>0.05). The levels of D-lactate and endotoxin in group B were lower than those in group A(P<0.05). Conclusion: Compared with Pringle method, HVC can effectively shorten the hospitalization time, reduce the damage of liver function and intestinal mucosa barrier, and do not increase the incidence of complications, so it has a higher clinical application value.