Application Of Controlled Low Central Venous Pressure Combined With Pringle Method In Laparoscopic Hepatocellular Carcinoma Resection

China is A country with A high incidence of primary liver cancer,and comprehensive treatment centered on surgical resection is mainly carried out for patients with liver cancer with BCLC stage 0-A[1].However,liver anatomical structure is complex and blood supply is rich,so the control of intraoperative bleeding is the key to ensure the smooth operation of liver surgery and rapid recovery of liver function after surgery.According to the distribution of liver blood supply,it can be divided into portal vein and hepatic vein.Hepatic blood flow occlusion technique is a technique to reduce hepatic perfusion by blocking the blood vessels supplying the liver by blocking the band during liver surgery,so as to reduce the incision bleeding of the liver during surgery.There are various techniques for hepatic blood flow occlusion,among which Pringle method is the most commonly used and effective.However,with the popularity of laparoscopic surgery,operators have put forward higher requirements for the control of intraoperative blood loss.For the occlusion of hepatic blood flow,the traditional method of total hepatic blood flow occlusion will lead to postoperative liver failure and other complications,resulting in death of patients in serious cases,so it is rarely applied in clinical practice.The progress of anesthesia technology enables anesthesiologists to implement low controlled low central venous pressure（CLCVP）in a variety of ways.While reducing hepatic venous blood pressure reflux,CLCVP does not completely block hepatic blood flow,preventing hepatic ischemia injury caused by hepatic blood flow occlusion[2].However,there are still controversies about the safety and effectiveness of Pringle combined with controlled low central venous pressure.Therefore,a retrospective study of 80 patients with laparoscopic partial hepatectomy was conducted to compare and discuss the results.Objective:To discuss the clinical significance of controlled low central venous pressure combined with Pringle method in laparoscopic hepatocellular carcinoma resection.Mater and Methods:A retrospective study was conducted on 80 patients who underwent laparoscopic partial hepatectomy for liver cancer in hospital of Jilin University from January2020 to December 2021.According to whether the patients underwent controlled low central venous pressure during the operation,the patients were divided into CLCVP group（40 cases）and Pringle group（40 cases）.Operative time,intraoperative blood loss,times of occlusion and duration of occlusion were compared between the two groups.The indexes of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin,direct bilirubin,creatinine and urea nitrogen on the first day after surgery were compared.Results:Intraoperative data: The operative time,intraoperative blood loss,times of occlusion and duration of occlusion in CLCVP group were all shorter than those in Pringle group.Postoperative data: ALT and AST in CLCVP group were lower than those in the Pringle group on the first postoperative day,and the differences in other indicators were not statistically significant.There were no serious postoperative complications in both groups,and only 3 patients developed mild abdominal effusion due to postoperative hypoalbuminemia.Conclusion:Combined implementation of CLCVP can effectively reduce intraoperative bleeding in liver surgery compared with Pringle method alone,thus shortening the duration of surgery,times of occlusion and duration of occlusion.Combined implementation of CLCVP can reduce postoperative liver injury by reducing surgical bleeding,surgical duration,number and duration of occlusion,which is conducive to postoperative recovery of liver function.It is a safe and effective method and is worth recommending in liver surgery.