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术中超声在Pringle手法腹腔镜肝切除术中的应用:与Pringle手法的对比研究

Application of Intraoperative Ultrasound in Laparoscopic Liver Resection with Pringle Maneuver: A Comparative Study with the Pringle Maneuver.

作者信息

Xiao Gang, Tang Haijun, Lu Baochun

机构信息

Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, China.

出版信息

J Laparoendosc Adv Surg Tech A. 2025 Jan;35(1):15-21. doi: 10.1089/lap.2024.0153. Epub 2024 Nov 19.

Abstract

Appropriate surgical techniques for controlling bleeding and preserving residual liver function are key to the success of laparoscopic liver resection. This study aims to evaluate the application effect of intraoperative ultrasound in the Pringle maneuver of laparoscopic liver resection. Between January 2022 and June 2023, 100 patients underwent laparoscopic liver resection and were randomly allocated to receive application of intraoperative ultrasound for Pringle maneuver (intraoperative ultrasound group, = 50) or conventional Pringle maneuver (conventional group, = 50). Intraoperative blood loss, blood transfusion, operation time, hepatic portal block time, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failure), and hospital stay were compared between groups, along with the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels at postoperative days 1, 3, and 7. The operation time, postoperative ALT, AST, and TB levels on postoperative days 1, 3, and 7, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failures), and hospital stay were comparable between groups. Compared with the conventional group, the intraoperative ultrasound group had significantly less intraoperative blood loss ( = .015), lower blood transfusion rate ( = .035), and less hepatic portal block time ( = .012). Applying intraoperative ultrasound in laparoscopic liver resection for hepatic pedicle occlusion is a safe, simple, and effective method.

摘要

采用合适的手术技术控制出血并保留残余肝功能是腹腔镜肝切除术成功的关键。本研究旨在评估术中超声在腹腔镜肝切除术Pringle手法中的应用效果。2022年1月至2023年6月,100例行腹腔镜肝切除术的患者被随机分为两组,分别接受术中超声引导下的Pringle手法(术中超声组,n = 50)或传统Pringle手法(传统组,n = 50)。比较两组患者的术中出血量、输血量、手术时间、肝门阻断时间、并发症(胆漏、出血、腹水和肝切除术后肝衰竭)及住院时间,以及术后第1、3、7天的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TB)水平。两组患者的手术时间、术后第1、3、7天的ALT、AST和TB水平、并发症(胆漏、出血、腹水和肝切除术后肝衰竭)及住院时间相当。与传统组相比,术中超声组术中出血量显著减少(P = 0.015),输血率更低(P = 0.035),肝门阻断时间更短(P = 0.012)。在腹腔镜肝切除术中应用术中超声进行肝蒂阻断是一种安全、简单且有效的方法。

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