Application Value Of Intermittent Pringle Method And Regional Hepatic Flow Occlusion In Laparoscopic Hepatectomy For Hepatocellular Carcinoma

Objective:To investigate the application value of laparoscopic intermittent Pringle method and regional intrahepatic blood flow occlusion in laparoscopic hepatectomy for hepatocellular carcinoma.Methods:According to inclusion and exclusion criteria,data of 155 patients who underwent laparoscopic hepatectomy and were pathologically diagnosed with hepatocellular carcinoma in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Nanchang University from January 2017 to January 2020 were collected and analyzed.They were divided into three groups: IPM group,regional occlusion group(regional occlusion group),and combined occlusion group.IPM group: 59 patients,including 52 males and 7 females,aged(54±12)years;Regional group: 74 patients,including 60 males and 14 females,aged(55±13)years;Combined occlusion group: 22 patients,19 males and 3 females,aged(52±11)years.This study focused on comparing the differences between the IPM group and the regional group in blood loss,operation time,conversion rate,postoperative complications,postoperative liver function indexes,etc.,and analyzing the changes of ALT and AST before and after surgery with the number of days in hospital between the two groups.Because the baseline data of the combined occlusion group were inconsistent with those of the other two groups(large tumors,special tumor locations that were difficult to expose,or tumors close to the first and second hilar vessels),this study did not participate in the comparison,only statistical descriptions were used.Results:Baseline data of the regional group and the IPM group were consistent and comparable(all P> 0.05).The IPM group(n=59)and the regional group(n=74)had no statistical significance in operation time,conversion rate,blood transfusion rate,complication rate and postoperative hospital stay(all P > 0.05).The intraoperative blood loss of the IPM group was significantly higher than that of the regional group(P<0.05).There were no significant differences in ALT,AST and PT between the two groups at each time point after surgery(all P > 0.05).The TBil of IPM group on the1 st and 5th day after surgery was significantly higher than that of the regional group(all P<0.05),there was no significant difference in TBIL between the two groups on the 3rd postoperative day(P > 0.05).The ALB of the IPM group was lower than that of the regional group on the 5th day after surgery(P < 0.05),and there was no statistical difference in ALB between the two groups on the 1st and 3rd day after surgery(all P>0.05).ALT and AST in both groups recovered close to the preoperative level on the 5th day after operation.In the combined occlusion group,the mean operation time was 230 min,and the mean blood loss was 344 m L.No patients were transferred to open surgery,and no postoperative complications such as liver failure,bile leakage,and abdominal bleeding occurred.Conclusion:1.Intermittent Pringle method and regional hepatic blood flow occlusion method were both safe and effective in laparoscopic hepatectomy for liver cancer;2.Compared with intermittent Pringle method,regional blood flow occlusion in laparoscopic hepatectomy for hepatocellular carcinoma can reduce intraoperative blood loss and postoperative liver function injury;3.For some difficult laparoscopic hepatectomy of liver cancer,the combination of the above two blocking methods is also safe and effective.