摘要
目的探讨低中心静脉压(LCVP)技术在肝硬化患者腹腔镜肝切除术中的应用价值。方法回顾性分析2014年3月至2018年4月在中山大学附属第五医院行腹腔镜肝切除术的95例肝硬化患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男51例,女44例;年龄33～69岁,中位年龄44岁。根据术中有否采用LCVP分为LCVP组(48例)和对照组(47例)。LCVP组切肝期间维持中心静脉压(CVP)<5 cmH_2O(1 cmH_2O=0.098 kPa)。两组患者围手术期指标比较采用t检验。结果 LCVP组切肝时间、手术时间、术中出血量、术中输血量分别为(28±3)min、(132±15)min、(102±18)ml、(35±5)ml,明显少于对照组的(39±3)min、(169±19)min、(235±19)ml、(78±7)ml(t=-11.34,-10.55,-35.03,-34.51;P<0.05)。LCVP组术后引流量、引流管留置时间、术后1 d的ALT分别为(50±9)ml、(28±10)min、(101±16)U/L,明显少于对照组的(97±11)ml、(36±11)min、(189±19)U/L(t=-22.81,-3.71,-24.44;P<0.05)。结论 LCVP技术可减少肝硬化患者腹腔镜肝切除术中出血量、缩短手术时间、改善术后肝功能,提高患者的安全性,且对术后肾功能无影响。
Objective To explore the application value of low central venous pressure (LCVP) technique in the laparoscopic hepatectomy in liver cirrhosis patients. Methods Clinical data of 95 patients with liver cirrhosis who underwent laparoscopic hepatectomy in the Fifth Affiliated Hospital of Sun Yat-sen University from March 2014 to April 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 51 patients were male and 44 female, aged 33-69 years with a median age of 44 years. The patients were divided into LCVP group (n=48) and control group (n=47) according to whether LCVP was applied during operation. In LCVP group, the central venous pressure (CVP) was maintained below 5 cmH2O (1 cmH2O=0.098 kPa) during liver resection. The perioperative indexes were compared between two groups by t test. Results In LCVP group, the liver resection time, operation time, intraoperative blood loss and intraoperative blood transfusion were (28±3) min,(132±15) min,(102±18) ml and (35±5) ml respectively, significantly less than (39±3) min,(169±19) min,(235±19) ml and (78±7) ml in control group (t=-11.34,-10.55,-35.03,-34.51;P<0.05). In LCVP group, the postoperative drainage volume, retention time of drainage tube and ALT level at postoperative 1 d were (50± 9) ml,(28±10) min and (101±16) U/L, significantly less than (97±11) ml,(36±11) min and (189±19) U/L in control group (t=-22.81,-3.71,-24.44;P<0.05). Conclusions LCVP can reduce the volume of intraoperative bleeding, shorten the operation time, improve the postoperative liver function and safety of surgery in patients with liver cirrhosis, and it exerts no effect upon the postoperative renal function.
作者
杨禄坤
范东毅
孔凡根
蔡潮农
李坚
Yang Lukun;Fan Dongyi;Kong Fangen;Cai Chaonong;Li Jian(Department of Anesthesiology,the Fifth Affiliated Hospital ofSun Yat-sen University, Zhuhai 519000, China;Department of Cerebral Surgery, the Fifth Affiliated Hospital ofSun Yat-sen University, Zhuhai 519000, China;Department of Hepatobiliary Surgery, the Fifth Affiliated Hospital ofSun Yat-sen University, Zhuhai 519000, China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2019年第2期139-142,共4页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
中山大学高校基本科研医科青年培育项目(17ykpy60)
关键词
中心静脉压
肝切除术
腹腔镜
肝硬化
Central venous pressure
Hepatectomy
Laparoscopes
Liver cirrhosis
