腹腔镜肝切除术中肝下下腔静脉部分阻断对中心静脉压和术中出血量的影响。
Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy.
机构信息
Department of Hepatobiliary Surgery, Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, China.
Department of Anesthesia, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, People's Republic of China.
出版信息
Surg Endosc. 2021 Jun;35(6):2773-2780. doi: 10.1007/s00464-020-07709-y. Epub 2020 Jun 30.
BACKGROUND
Infrahepatic inferior vena cava (IVC) clamping is considered to be an effective method to reduce central venous pressure (CVP) and intraoperative bleeding in liver resection. However, its efficacy and safety during laparoscopic hepatectomy (LH) remain unclear. We perform this retrospective study to evaluate its efficacy and safety during LH.
METHODS
Consecutive patients scheduled for LH from September 2014 to August 2019 were retrospectively reviewed. The intraoperative parameters and postoperative outcomes were analyzed.
RESULTS
All patients in the infrahepatic IVC clamping group were able to tolerate partial clamping of IVC. The CVP was significantly decreased after infrahepatic IVC clamping without hemodynamic instability (8.7 ± 1.4 cmHO vs. 2.1 ± 1.3 cmHO, P = 0.000). Infrahepatic IVC clamping did not significantly reduce total blood loss (287.3 ± 112.5 mL vs. 301.4 ± 127.6 mL, P = 0.133) and blood loss during parenchymal transection (273.2 ± 107.9 mL vs. 296.5 ± 118.1 mL, P = 0.618) compared with the non-clamping group. In subgroup analysis, total blood loss and blood loss during parenchymal transection were significantly reduced in patients with moderate to severe cirrhosis in the clamping group (363.6 ± 71.2 mL vs. 473.4 ± 95.6 mL, P = 0.021), (358.7 ± 70.9 mL vs. 466.9 ± 94.5 mL, P = 0.016), respectively. The complications and hospital stay were comparable.
CONCLUSIONS
In conclusion, these data suggest that infrahepatic IVC clamping may be safe and effective.
背景
肝下下腔静脉（IVC）夹闭被认为是一种降低肝切除术中心静脉压（CVP）和术中出血的有效方法。然而，其在腹腔镜肝切除术（LH）中的疗效和安全性仍不清楚。我们进行这项回顾性研究，以评估其在 LH 中的疗效和安全性。
方法
回顾性分析 2014 年 9 月至 2019 年 8 月连续接受 LH 的患者。分析术中参数和术后结果。
结果
所有接受肝下 IVC 夹闭的患者均能耐受 IVC 的部分夹闭。肝下 IVC 夹闭后 CVP 明显下降，无血流动力学不稳定（8.7±1.4 cmHO 比 2.1±1.3 cmHO，P=0.000）。肝下 IVC 夹闭并未显著减少总出血量（287.3±112.5 mL 比 301.4±127.6 mL，P=0.133）和肝实质切开时的出血量（273.2±107.9 mL 比 296.5±118.1 mL，P=0.618）与非夹闭组相比。亚组分析显示，中重度肝硬化患者夹闭组的总出血量和肝实质切开时的出血量明显减少（363.6±71.2 mL 比 473.4±95.6 mL，P=0.021），（358.7±70.9 mL 比 466.9±94.5 mL，P=0.016）。并发症和住院时间无差异。
结论
总之，这些数据表明肝下 IVC 夹闭可能是安全有效的。
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