78例肝硬化患者肠道细菌易位及其相关性研究

目的了解肝硬化患者肠道细菌易位（BT）的发生率及其相关危险因素,分析BT与术后感染的关系。方法对77例肝移植和1例未行肝移植的肝硬化患者进行术中采样,取外周血、门脉血及肠系膜淋巴结（MLN）,分别进行需氧及厌氧培养,了解BT的发生率。结合术前、术后各种临床资料分析发生BT的危险因素及BT的临床意义。结果78例肝硬化患者中BT的发生率为10．3％（8／78）;细菌易位的部位以MLN为主,占5／8,发生BT的细菌主要是肠道G-兼性厌氧杆菌（55．6％）,其次为G^＋兼性厌氧球菌（22．2％）。BT组患者术前胆红素总量显著高于无BT组（P=0．022）;发生BT的患者其术后感染的风险是无BT患者的1．3倍。结论高胆红素血症是促发BT的独立危险因素,发生BT的肝移植患者术后感染的风险明显升高。     

Water-soluble ethylhydroxyethyl cellulose prevents bacterial translocation induced by major liver resection in the rat.

Enteric bacteria might act as pathogens, translocating across the intestinal barrier to extraintestinal sites after major liver resection. In the current study, water-soluble ethylhydroxyethyl cellulose (EHEC) was administered before hepatectomy to evaluate the influence on bacterial translocation induced by major liver resection, phagocytic capacity by visceral and circulating macrophages, enteric bacterial population, and bacterial adherence on the intestinal surface in rats subjected to sham operation or to 70% or 90% hepatectomy. Oral or intravenous (IV) administration of EHEC reduced the incidence of bacterial translocation to mesenteric lymph nodes (MLN) and blood after major liver resection. Oral EHEC appeared more effective than IV administration in protecting against bacterial translocation to MLN in animals with 90% hepatectomy. Ethylhydroxyethyl cellulose (oral and IV) significantly diminished intestinal macrophage uptake capacity of 125I-labeled, heat-killed Escherichia coli as compared with animals without EHEC administration. Overgrowth or colonization of enteric bacteria after major liver resection could be prevented by oral or IV EHEC. Adherence of 14C-labeled, alive E. coli on the intestinal mucosa decreased after EHEC treatment in animals subjected to major liver resection. Systemic arterial pressure and intestinal blood flow markedly decreased from 1 hour and on after 90% hepatectomy. Intravenous administration of EHEC did not improve these alterations. Bacterial hydrophobicity and surface negative charge were significantly reduced 1 hour after bacterial culture with EHEC. Thus, EHEC appears to be a potent agent preventing translocation of enteric bacteria from the gut after major liver resection, by altering the surface characters of enteric bacteria, balancing the enteric microflora, inhibiting bacterial attachment onto the intestinal surface, and blocking phagocytosis by intestinal macrophages.     

Gut bacterial translocation and postoperative infections: a prospective study in schistosomotic patients

BACKGROUND: Bacterial translocation (BT) across the intact intestinal mucosal barrier has been postulated as a source of sepsis in susceptible patients, including those with cirrhosis and portal hypertension. This condition has not been studied in hepatosplenic schistosomiasis, wherein portal hypertension and the presence of an immune deficiency state associated with the parasitic disease could predispose to BT into mesenteric lymph nodes (MLN). A study was conducted to determine the prevalence of aerobic bacteria in MLN (bacterial translocation) of patients with hepatosplenic schistosomiasis, and establish a possible association with postoperative infections. METHODS: In a series of 51 patients submitted to surgical treatment of schistosomotic portal hypertension with splenectomy and gastric devascularization, MLN were obtained from each patient at the beginning (MLN1) and at the end (MLN2) of the surgical procedure, and sent for bacteriological analysis. Prospective patient evaluation during the postoperative period correlated positive MLN cultures with infectious complications. RESULTS: The prevalence of aerobic bacteria was 17.6% at MLN1 and 27.5% at MLN2, however, this difference was non-significant (p = 0.24). Bacterial translocation to all MLN was 22.5%. Escherichia coli was the most frequent organism (26.1%, 6/23). The overall incidence of postoperative infections was 19.6% (10/51), with a significant association with the presence of positive cultures of MLN (p = 0.043). CONCLUSIONS: The findings of this study suggest that the presence of aerobic bacteria on MLN as a consequence of BT may play a role in the development of postoperative infectious complications, particularly in schistosomotic patients.     

大鼠脊髓损伤致截瘫后肠道细菌移位的实验研究

目的：探讨大鼠脊髓损伤致截瘫后是否发生肠道细菌移位。方法：建立大鼠脊髓损伤性截瘫模型，以脊髓损伤性截瘫后12h、24h、48h大白鼠为实验组，未损伤脊髓的正常大白鼠为对照组。在无菌条件下，采集动物下腔静脉血进行内毒素定量测定和细菌培养，采集肝、脾、肠系膜淋巴结、肠腔内容物作细菌培养并进行菌种鉴定。取实验组和对照组各动物的肝、脾、肠系膜淋巴结、空肠、回肠进行病理切片HE染色检查，取空、回肠进行电镜检查。结果：大鼠脊髓损伤致截瘫后24h开始出现内毒素血症，截瘫后48h出现细菌移位。结论：大鼠脊髓损伤致截瘫后将发生肠道细菌移位，提示脊髓损伤截瘫的病人应尽早给予抗生素治疗。     

Administration of branched chain amino acids prevents bacterial translocation after liver resection in the cirrhotic rat

After major liver resection, bacterial infectious complications, including sepsis and endotoxemia, can be at least in part, attributed to translocation of enteric bacteria and endotoxin. We evaluated the effectiveness of the enteral and parenteral administration of branched-chain amino acids (BCAA) in preventing bacterial translocation after 70% liver resection in rats with thioacetamide-induced-cirrhosis. Bacterial translocation after hepatectomy was induced by a disturbance of protein metabolism in intestinal epithelial cells. However, the administration of BCAA, particularly via the enteral route, improved amino acid metabolism in the gut and stimulated the synthesis of nonsecreted protein and the proliferation of crypt cells, thereby preventing bacterial translocation after liver resection. Improvement in this cascade of metabolic reactions is believed to have been responsible for the improved outcome after extensive resection of the cirrhotic liver.     

活体肝移植供体及有或无肝硬变肝病患者右半肝切除术后预后的比较分析

目的探讨活体肝移植供体和肝病患者行右半肝切除术后的预后是否相似。方法纳入笔者所在医院肝脏移植中心2009～2010年期间的连续病例,包括40例不含肝中静脉的活体右半肝供体（活体肝移植供体组,简称LDLT-D组）及80例因肝病行右半肝切除的患者,其中40例为无肝硬变的肝病患者（无肝硬变肝病组,简称LD-NC组）及40例伴肝硬变的肝病患者（肝硬变肝病组,简称LD-WC组）。分析3组患者术前肝功能和一般临床资料,术中失血量和输血量,以及术后肝功能情况和并发症发生情况。结果 3组患者术前特征相似。LDLT-D组患者术中出血量较LD-NC组多〔（765±411）mL比（584±242）mL,P=0.008〕,与LD-WC组〔（666±224）mL〕接近（P=0.136）,但3组患者术中平均输血量相近（P=0.108）。术后第1天和第3天,LDLT-D组患者的TB和INR水平高于LD-NC组和LD-WC组（P〈0.05）,LD-WC组患者的ALT和AST水平均高于LDLT-D组和LD-NC组（P〈0.05）。LDLT-D组、LD-NC组及LD-WC组患者术后总并发症发生率分别是30.0%（12/40）、27.5%（11/40）和37.5%（15/40）,3组间的差异均无统计学意义（P=0.606）,但LD-WC组的ClavienⅢ级并发症发生率〔27.5%（11/40）〕高于LDLT-D组〔7.5%（3/40）〕及LD-NC组〔10.0%（4/40）〕,P=0.024。结论在右半肝切除术后早期阶段,活体肝移植供体肝功能损害更重;活体肝移植供体、无肝硬变的肝病患者和伴肝硬变的肝病患者术后总并发症发生率相近,但伴肝硬变肝病患者的严重并发症发生率高于活体肝移植供体及无肝硬变肝病患者。     

Bacterial translocation after major hepatectomy in patients and rats.

Bacterial infections are frequent complications after liver resection. Of 138 patients who underwent major hepatectomy, 11 patients (8%) developed intra-abdominal sepsis in the postoperative period. Seven bacterial strains of gut origin were isolated from the abdominal cavity. Eight patients had multiple bacteria cultured. In the experimental studies on rat models, positive mesenteric lymph node cultures were seen 2 hours after removal of 70% and 90% of the total weight of the rat liver, and 12 hours after 50% hepatectomy, persisting for 3 and 4 days after 50% and 70% hepatectomy, respectively. The incidences of bacteremia 2 and 4 hours after 90% hepatectomy were 80% and 100%, respectively; 6 hours after 70% liver resection, the incidence of bacteremia was 33%. Blood cultures were positive in only 6% of the rats following 50% hepatectomy, and in none of the controls. Thus, bacterial translocation occurs in the early course after hepatectomy, the incidence being proportional to the amount of liver tissue removed.     

Perioperative parenteral tranexamic acid in liver tumor resection: a prospective randomized trial toward a "blood transfusion"-free hepatectomy

OBJECTIVE: To examine the feasibility of a real "blood transfusion"-free hepatectomy in a large group of patients with liver tumors. SUMMARY BACKGROUND DATA: Bleeding control and blood transfusion remains problematic in liver resection. A real "blood transfusion"-free hepatectomy in a large group of patients has rarely been reported. The impact of tranexamic acid (TA), an antifibrinolytic agent, on blood transfusion in liver resection is unknown. METHODS: A prospective double-blind randomized trial was performed on elective liver tumor resections. In group A, TA 500 mg was intravenously administered just before operation followed by 250 mg, every 6 hours, for 3 days. In group B, only placebo was given. The patients' background, blood transfusion rates, and early postoperative results in the 2 groups were compared. Factors that influenced blood requirement were analyzed. RESULTS: There were 108 hepatectomies in group A and 106 hepatectomies in group B. The patients' backgrounds, operative procedures, and hepatectomy extent did not significantly differ between the 2 groups. Although the differences of the operative morbidity and postoperative stay were not significant, a significantly lower amount of operative blood loss, lower blood transfusion rate, shorter operative time, and lower hospital costs were found in group A patients. No patient in group A received blood transfusion. No hospital mortality occurred in either group. Tumor size and use of TA were independent factors that influenced blood transfusion. CONCLUSIONS: Perioperative parenteral use of TA reduced the amount of operative blood loss and the need for blood transfusion in elective liver tumor resection. A real "blood transfusion"-free hepatectomy may be feasible with the assistance of parenteral TA.     

不同肝血流阻断方法在肝切除术中的效果比较

目的比较Pringle法（Pringle组）、选择性门脉血流阻断法（selective portal venous exclusion,SPVE,SPVE组）及Glisson鞘选择性入肝血流阻断法（selective Glisson sheath exclusion,SGSE,SGSE组）在肝脏切除手术中的效果及临床意义。方法回顾性分析2006年8月至2012年3月期间于中南大学湘雅医院采用上述3种肝脏血流阻断方法行肝脏切除手术患者的临床资料,比较3组患者的手术时间、血流阻断时间、失血量、输血率、术后肝功能、并发症发生率及住院时间指标。结果 3组患者的术前情况、手术时间、血流阻断时间、肿瘤特征、术后血常规及肝功能、住院时间及ICU时间的差异均无统计学意义（P〉0.05）;SGSE组患者的术中出血量及输血者比率均明显少或低于Pringle组和SPVE组（P〈0.05）;SPVE组和SGSE组术后各时间（除术后第1天外）的AST及ALT较Pringle组改善明显（P〈0.05）,TBIL在第3、5天较Pringle组显著改善（P〈0.05）;SPVE组和SGSE组的并发症发生率低于Pringle组（P〈0.05）。结论 SGSE法能够在相似的手术时间和血流阻断时间内,能更好地控制患者的术中出血量与输血率,有利于术后肝功能的恢复,并降低了术后并发症的发生,具有一定的优越性。但手术时仍要根据实际情况选择阻断方式。     

选择性半肝血流阻断在肝海绵状血管瘤切除中的应用

目的:探讨选择性半肝血流阻断在肝海绵状血管瘤切除中的应用效果。方法:回顾性分析2006年1月—2011年1月经手术切除的104例肝海绵状血管瘤患者的临床资料。其中26例行选择性半肝血流阻断(A组),78例行第一肝门阻断(Pringle法)(B组)。比较并分析两种方法对术中情况、术后肝功能恢复、并发症发生率等指标的影响。结果:104例手术均顺利完成。两组间术中失血量、输血量、阻断时间、血氧饱和度以及术后肠道恢复时间、并发症等指标的差异均无统计学意义(均P>0.05),但B组术中外周动脉血压及术中脉搏变化明显大于A组(均P<0.01)。术后肝功能指标如ALT,AST,ALB,TBIL等改变,B组优于A组,差异均有统计学意义(P<0.05或P<0.01)。结论:肝海绵状血管瘤切除术中采用选择性半肝血流阻断,能有效地减轻肝血流阻断对全身血流动力学的影响,减轻缺血再灌注损伤,有利于术后肝功能恢复。     

Re-evaluation of the necessity of prophylactic drainage after liver resection

Abdominal drainage after liver resection is considered unnecessary: however, there still exist a number of cases where drain is effective to prevent serious infectious complications. We re-evaluated the necessity of drain placement after liver resection from the retrospective analysis of postoperative complications with special reference to the need for drain insertion of 140 patients undergoing hepatectomy without intraoperative abdominal drainage from 2007 through 2010. Three patients required drain reinsertion in the early postoperative period (before postoperative Day 7); all had undergone extended right hepatectomy for hepatocellular carcinoma with portal vein thrombus followed by postoperative liver failure. Risk factors for postoperative bile leakage included repeated hepatectomy, operative procedure with exposure of the major Glisson's sheath (i.e., central bisegmentectomy and anterior segmentectomy), and intraoperative bile leakage. However, because the onset of this complication was as late as postoperative Day 19.5, prophylactic drainage does not appear useful. Although not required routinely, prophylactic drainage might be useful in patients undergoing extended hepatectomy, a high-risk hepatectomy procedure exposing the major Glisson's sheath, those with positive intraoperative bile leakage, for hepatocellular carcinoma, and especially complicated with portal vein thrombus.     

Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method

BACKGROUND: Abdominal drainage is a standard procedure after hepatectomy, but this practice has been challenged recently. METHODS: Between September 2004 and March 2005, 120 consecutive patients who had undergone hepatic resection by the same surgical team were randomly allocated into drainage and no drainage groups (60 in each group). Patient characteristics, preoperative liver function, presence of cirrhosis, resection-related factors and postoperative complications were compared between the two groups. RESULTS: The groups were comparable in terms of demographics, indications for surgery, preoperative liver function test results, presence of cirrhosis, extent of hepatectomy, intraoperative blood loss and requirement for blood transfusion. Symptomatic subphrenic collection and pleural effusion occurred in four patients (7 per cent) who had abdominal drainage and three (5 per cent) who did not. Local wound complications occurred in 17 (28 per cent) and two (3 per cent) patients respectively (P < 0.001). The postoperative hospital stay was similar in the two groups. Multivariate analysis indicated that the presence of cirrhosis and abdominal drainage were independently related to the development of postoperative wound complications. CONCLUSION: Routine abdominal drainage is unnecessary after elective hepatectomy using the crushing clamp method.     

选择性肝血流阻断技术在腹腔镜左肝外叶切除术中的应用

目的 探讨选择性肝血流阻断技术在腹腔镜左肝外叶切除术中应用的可行性和有效性。方法 回顾分析18例术中采用选择性肝血流阻断技术实施腹腔镜左肝外叶切除术患者的临床资料。结果 全组均在腹腔镜下完成手术,无中转开腹,无围手术期死亡。平均手术时间（140±58）min,平均术中出血量（160±148）mL,均未术中输血。术后1例患者发生左膈下积液,术后并发症发生率为5.56%（1/18）,平均术后住院时间（6.4±2.5）d。结论 腹腔镜左肝外叶切除术中采用选择性肝血流阻断技术可有效减少术中出血和术后并发症,安全可行。     

Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques

BACKGROUND: Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations. HYPOTHESIS: Hemihepatic inflow occlusion may be beneficial in cirrhotic patients who undergo complex central hepatectomy with a wide liver transection plane. DESIGN: A prospective, randomized study. SETTING: University hospital and tertiary referral center. PATIENTS: During liver parenchymal transection, 58 cirrhotic patients who underwent complex central liver resections with a wide transection plane were prospectively randomized into 2 groups. In the group undergoing total hepatic inflow clamping (group T; n = 28), occlusion of hepatic blood inflow was performed for 15 minutes with declamping for 5 minutes. In the group undergoing selective clamping of ipsilateral blood inflow (group H; n = 30), clamping was performed for 30 minutes with declamping for 5 minutes. INTERVENTION: Comparison of patient backgrounds, operative procedures, and early postoperative results. MAIN OUTCOME MEASURES: Operative blood loss, need for blood transfusion, and postoperative morbidity. RESULTS: The patients' backgrounds, operative procedures, and area of liver transection plane were not significantly different between the 2 groups. In all patients, the liver transection areas were greater than 60 cm(2) and overall liver ischemic times were greater than 60 minutes. The amount of operative blood loss and incidence of blood transfusion were significantly greater in group T because of greater blood loss during declamping. Overall liver ischemic and total operative times, postoperative morbidity, and postoperative changes in liver enzyme levels were not significantly different between groups. No in-hospital deaths occurred in either group. CONCLUSIONS: Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm(2), hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.     

Probiotic supplementation reduces the risk of bacterial translocation in experimental short bowel syndrome

Background/Purpose: Probiotics are live organisms that survive passage through the gastrointestinal tract and have beneficial effects on the host. Lactobacillus and Bifidobacterium have been recommended for cholesterol lowering, acute diarrhea, prevention of cancer, or inflammatory bowel disease. On the other hand, after massive bowel resection, bacterial overgrowth is frequent and favors bacterial translocation (BT). The possible beneficial effects of Bifidobacterium lactis (BL) administration on BT in experimental short bowel syndrome (SBS), have not been investigated. The aim of this study was to test the hypothesis that BL administration decreases BT in SBS in animals fed orally. Methods: One hundred twenty-eight adult Wistar rats fed orally with standard rat chow and tap water [ldquo ]ad libitum[rdquo ] were maintained in individual metabolic cages for 10 days and divided into 3 groups: control group (n = 71): nonmanipulated animals; RES group (n = 39): 80% gut resection from 10 cm beyond the angle of Treitz to 10 cm above the cecum; RES-PRO group (n = 18): same resection and daily 7.8 [times ] 10⁸ CFU B Lactis administration, after orogastric intubation. At the end of the experiment they were killed, and mesenteric lymph nodes (MLN) and peripheral and portal blood specimens were recovered and cultured. Bacterial identification in blood was made by conventional methods, and MLN culture was considered positive with a growth over 100 CFU/g. Results: Bacterial translocation was detected in 6% of control group rats. The incidence of BT in the RES group was 87% (34 of 39), whereas only 50% (9 of 18) of RES-PRO animals had BT (P [lt ] .05). The relative risk reduction (RRR) was 0.43 (95% Cl 0.14 to 0.72), and the number needed to treat (NNT) was 3 (95% Cl 2 to 8). In other words, animals that received BL had the risk of BT reduced by 43% (RRR of 0.43), and of every 3 animals treated, 1 is expected to be free of BT (NNT of 3). Conclusion: Administration of B Lactis reduces the incidence of BT in adult Wistar rats after 80% gut resection.     

Improving operative safety for cirrhotic liver resection

BACKGROUND: Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose safe strategies for cirrhotic liver resection. METHODS: Based on the date of operation, 359 cirrhotic liver resections in 329 patients were divided into two intervals: period 1, from September 1989 to December 1994, and period 2, from January 1995 to December 1999. The patient backgrounds, operative procedures and early postoperative results were compared between the two periods. The factors that influenced surgical morbidity were analysed. RESULTS: In period 2, patient age was higher and the amounts of blood loss and blood transfused were lower. Although postoperative morbidity rates were similar, blood transfusion requirement, postoperative hospital stay and mortality rate were significantly reduced in period 2. No death occurred in 154 consecutive cirrhotic liver resections in the last 38 months of the study. Prothrombin activity and operative time were independent factors that influenced postoperative morbidity. CONCLUSION: With improving perioperative assessment and operative techniques, most complications after cirrhotic liver resection can be treated with a low mortality rate. However, more care should be taken if prothrombin activity is low or there is a long operating time.     

肥胖对肝癌患者肝切除术预后的影响

目的 研究分析肥胖对肝癌患者肝切除术预后的影响。方法 前瞻性分析1996年2月至2002年12月之间我院470例行肝切除术的肝细胞癌患者临床资料。根据体质量指数（BMI）,将患者分为非肥胖组和肥胖组,肥胖组105例,其中男94例,女11例,平均年龄53岁,伴有肝硬化76例;非肥胖组365例,其中男311例,女54例,平均年龄50岁,伴有肝硬化263例。对比分析两组肝癌术后的结局。结果 与非肥胖组比较,肥胖组的年龄、术中输血、术中失血量均存在统计学差异（P＜0.05）。单因素分析显示,肥胖组的总生存率及无瘤生存率明显比非肥胖组要低（P＜0.05）。COX多因素分析,影响生存的因素包括肿瘤大小、包膜、术中失血量及MVI、BMI分级;影响肝癌复发的因素包括肿瘤大小、乙肝感染、肝硬化、包膜、术中失血量、术中输血及BMI分级。结论 肥胖是影响肝癌患者肝切除术预后的独立危险因素。     

大肝癌手术切除术中不同肝血流阻断方法的临床研究

目的：比较大肝癌手术切除术中3种不同的入肝血流阻断法的临床效果。
　　方法：回顾性分析2011年1月—2013年3月期间218例大肝癌（>5cm）手术患者的临床资料,术中88例采用Pringle法间断阻断全肝血流（肝门阻断组）,51例行选择性的半肝血流阻断（半肝阻断组）,79例行肝下下腔静脉阻断联合Pringle法阻断入肝血流（联合阻断组）。比较3组患者的术中与术后的相关指标。
　　结果：3组患者的术前情况、手术时间、入肝血流阻断时间及肝切除量的差异均无统计学意义（均P>0.05）;半肝阻断组与联合阻断组的术中出血量、输血量、输血率均明显低于肝门阻断组,且联合阻断组的输血量、输血率明显低于半肝阻断组（均P<0.05）;3组患者术后第1天肝功能指标差异无统计学意义（均P>0.05）,但半肝阻断组与联合阻断组第3、7天的转氨酶和总胆红素水平均明显低于肝门阻断组（均P<0.05）;3组术后并发症的发生率差异无统计学意义（P>0.05）。
　　结论：大肝癌切除术术中采用肝下下腔静脉阻断联合Pringle法阻断入肝血流不仅能够有效减少术中失血量,而且有利于术后肝功能的恢复。     

半肝与全肝入肝血流阻断下肝切除术后肠道细菌易位影响对比研究

目的探讨半肝血流阻断与第一肝门阻断法（Pringle法）对肝叶切除术后肠道细菌易位的影响。方法对2003-2006年中国人民解放军总医院及第一附属医院55例肝叶切除术病人分别选用两种不同阻断血流方法,术前和术后2h、24h、48h采集外周血,应用聚合酶链反应（PCR）方法检测全血细菌DNA,同时行血D 乳酸、内毒素（LPS）浓度检测。结果术前PCR均为阴性,术后共有32例PCR阳性,两组PCR阳性率差异有统计学意义（P<001）。全肝阻断组外周血浆D 乳酸及LPS浓度较半肝阻断组明显升高（P<001）。结论肝叶切除术中采用半肝血流阻断较全入肝血流阻断肠黏膜屏障受损较轻,肠道细菌易位明显减少。     

三维可视化技术结合术中超声在可切除肝癌腹腔镜手术的应用

目的探讨术前应用三维可视化技术结合术中超声实时引导在可切除原发性肝癌腹腔镜手术中应用的近期效果及价值。 方法回顾性分析蚌埠医学院第一附属医院2021年1月至2022年3月行腹腔镜肝切除术的68例原发性肝癌患者资料,根据术前是否行肝脏三维重建及术中超声引导,将患者分为对照组和观察组,各34例。对照组术前增强CT检查后行手术规划,观察组术前在增强CT的基础上采用三维可视化技术进行肝脏三维重建,拟定手术方案,术中行超声实时引导。对比两组患者的手术方式、术中出血量、术中输血比例、肝门阻断时间、手术时间、术后并发症发生率及术后住院时间。 结果与对照组相比,观察组患者术中出血量更少,术中输血比例更低,术中肝门阻断时间、手术时间及术后住院时间更短（均P<0.05）。对照组6例患者中转开腹,两组手术方式比较差异有统计学意义（χ²=4.570,P=0.033）。观察组术后总并发症发生率显著低于对照组（11.8% vs 35.3%,χ²=5.231,P=0.022）。 结论术前三维可视化技术结合术中超声引导在可切除原发性肝癌腹腔镜手术中的应用,有助于制定个体化手术策略,提升临床治疗效果,减少术中出血和肝门阻断时间,降低术后并发症的发生率,对腹腔镜肝切除手术的发展有重要指导意义。