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摘要：
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摘要：目的 探讨不同肝血流阻断方法在肝癌患者腹腔镜肝切除术中的效果差异。方法 以湖北省汉川
市人民医院2017年1月至2018年3月收治的183例拟行腹腔镜肝切除术的肝癌患者为研究对象，采用
随机数字表法将患者随机分为Pringle组、半肝阻断组和肝静脉控制组，每组61例，比较各组患者术
中手术指标（手术时间、术中出血量、肝血流阻断时间、住院时间）、治疗后肝功能指标[丙氨酸氨
基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate amino transferase，
AST）、总胆红素（total bilirubin，TBil）及前白蛋白]及血流动力学指标（平均动脉压、心率）的
差异，比较3组患者术后并发症的差异。结果 Pringle组、半肝阻断组和肝静脉控制组患者的手术时
间分别为（190.68 ± 15.46）min、（143.27 ± 10.42）min、（95.27 ± 11.37）min，差异有统计学意
义（F = 1198.173，P ＜ 0.001）；术中出血量分别为（684.27 ± 28.49）ml、（680.32 ± 25.39）ml、
（428.09 ± 17.26）ml，差异有统计学意义（F = 2707.174，P ＜ 0.001）；肝血流阻断时间分别为
（14.29 ± 2.12）min、（14.07 ± 2.55）min、（7.06 ± 1.32）min，差异有统计学意义（F = 281.404，
P ＜ 0.001）；住院时间分别为（14.26 ± 1.23）d、（14.36 ± 1.15）d、（8.56 ± 1.07）d，差异有统
计学意义（F = 506.814，P ＜ 0.001）。肝静脉控制组患者手术时间、术中出血量、肝血流阻断时间
和住院时间均显著低于Pringle组和半肝阻断组，差异有统计学意义（均P ＜ 0.001）。出院时，Pringle
组、半肝阻断组和肝静脉控制组患者ALT分别为（329.28 ± 25.43）U/L、（331.05 ± 26.30）U/L、
（256.17 ± 30.64）U/L，AST分别为（362.75 ± 37.18）U/L、（331.05 ± 26.30）U/L、（272.86 ± 25.17）U/L，
TBil分别为（40.26 ± 5.07）μmol/L、（41.37 ± 5.22）μmol/L、（49.86 ± 7.64）μmol/L，前白蛋白
分别为（175.89 ± 21.37）mg/L、（176.92 ± 23.55）mg/L、（208.94 ± 26.37）mg/L，各组患者手术
前、手术后和出院时上述指标的差异均有统计学意义（F值分别为2564.250、4356.289、3748.044、
6547.088，均P ＜ 0.001）。Pringle组、半肝阻断组和肝静脉控制组患者胸腔积液发生率分别为19.67%
（12/61）、18.03%（11/61）、3.28%（2/61），出血发生率分别为11.48%（7/61）、14.75（9/61）、
1.64（1/61），差异有统计学意义（χ 2 值分别为9.260、10.968，均P ＜ 0.001）。结论 肝癌患者腹腔镜
肝切除术中采用肝静脉控制阻断法，相比于Pringle法和半肝阻断法能更好地保护患者的肝功能，降低
并发症发生率。
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Abstract: Objective To investigate the effects of different hepatic blood flow blocking methods in
laparoscopic hepatectomy in patients with liver cancer. Methods Total of 183 patients with liver cancer
who underwent laparoscopic hepatectomy in Hanchuan People’s Hospital from January 2017 to
March 2018 were selected. Patients were randomly divided into Pringle group, semi-hepatic occlusion
group and hepatic vein controlled occlusion group according to random number table, 61 cases in each group.
The operation indexes (operation time, intraoperative blood loss, length of hospital stay and hepatic blood
flow blocking time), liver function indexes [alanine aminotransferase (ALT), aspartate aminotransferase
(AST), total bilirubin (TBil) and albumin] after treatment and hemodynamic indexes (mean arterial pressure
heart rate) were compared among three groups. The operation time, intraoperative blood loss, liver blood
flow blocking time, length of hospital stay and postoperative complications were also compared. Results
The operation time of patients in Pringle group, semi-hepatic occlusion group and hepatic vein controlled
occlusion group were (190.68 ± 15.46) min, (143.27 ± 10.42) min and (95.27 ± 11.37) min, respectively, the
difference was statistically significant (F = 1198.173, P ＜ 0.001); the intraoperative blood loss were (684.27 ±
28.49) ml, (680.32 ± 25.39) ml and (428.09 ± 17.26) ml, respectively, the difference was statistically significant
(F = 2707.174, P ＜ 0.001); the time of hepatic blood flow blocking were (14.29 ± 2.12) min, (14.07 ± 2.55)
min and (7.06 ± 1.32) min, respectively, the difference was statistically significant (F = 281.404, P ＜ 0.001); the
length of hospital stay were (14.26 ± 1.23) d, (14.36 ± 1.15) d and (8.56 ± 1.07) d, respectively, the difference
was statistically significant (F = 506.814, P ＜ 0.001). The operation time, intraoperative blood loss, time of
hepatic blood flow blocking and length of hospital stay of patients in hepatic vein controlled occlusion group
were significantly lower than those in Pringle group and semi-hepatic occlusion group, the differences were
statistically significant (all P ＜ 0.001). At discharge, ALT levels of patients in Pringle group, semi-hepatic occlusion
group and hepatic vein controlled occlusion group were (329.28 ± 25.43) U/L, (331.05 ± 26.30) U/L and (256.17 ±
30.64) U/L, respectively; AST levels were (362.75 ± 37.18) U/L, (331.05 ± 26.30) U/L and (272.86 ±
25.17) U/L, respectively; TBil levels were (40.26 ± 5.07) μmol/L, (41.37 ± 5.22) μmol/L and (49.86 ± 7.64) μmol/L,
respectively; albumin levels were (175.89 ± 21.37 U/L) mg/L, (176.92 ± 23.55 U/L) mg/L and (208.94 ±
26.37) mg/L, there were significant differences in the above indexes before, after operation and at discharge in
each group (F = 2564.250, 4356.289, 3748.044, 6547.088; all P ＜ 0.001). The incidence of pleural effusion
in Pringle group, semi-hepatic occlusion group and hepatic vein controlled occlusion group were 19.67%
(12/61), 18.03% (11/61) and 3.28% (2/61), respectively; the incidence of pleural effusion abdominal bleeding
were 11.48% (7/61), 14.75 (9/61) and 1.64 (1/61), respectively, the differences were statistically significant (χ 2 =
9.260, 10.968; all P ＜ 0.001). Conclusion Hepatic vein controlled occlusion in laparoscopic hepatectomy
in patients with liver cancer can protect the liver function of patients better and reduce the incidence of
complications compared with Pringle and semi-hepatic occlusion.
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