腹腔镜外科杂志2025，Vol.30Issue(9)：652-658,7.DOI:10.13499/j.cnki.fqjwkzz.2025.09.652
肝下下腔静脉阻断技术在腹腔镜解剖性中肝切除术治疗肝细胞癌中的应用
Application of infrahepatic inferior vena cava clamping in laparoscopic anatomic mesohepatectomy for hepatocellular carcinoma
摘要
Abstract
Objective:To evaluate the effect of infrahepatic inferior vena cava(IHIVC)clamping on intraoperative blood loss control and postoperative recovery in patients undergoing laparoscopic anatomic mesohepatectomy.Methods:A retrospective analysis was conducted on clinical data of 42 patients with hepatocellular carcinoma who underwent laparoscopic mesohepatectomy between Jan.2023 and Mar.2025.According to the intraoperative hemodynamic control strategies,patients were divided into an IHIVC group(IHIVC clamping,n=19)and a low central venous pressure(LCVP)group(controlled LCVP,n=23).Intraoperative hemodynamic parame-ters,surgical-related outcomes,and postoperative recovery were compared between the two groups.Results:There were no significant differences in baseline characteristics between the two groups,indicating comparability.The IHIVC group showed significantly lower central venous pressure[(1.88±0.48)cmH2O vs.(2.76±0.32)cmH2O,P＜0.001]and mean heart rate[(92.42±10.07)bpm vs.(103.43±10.24)bpm,P=0.001],along with reduced intraoperative blood loss[(205.58±86.62)mL vs.(322.87±178.22)mL,P=0.012],shorter operative time[(232.16±53.83)min vs.(265.43±86.62)min,P=0.040]and parenchymal transection time[(61.32±15.47)min vs.(76.61±20.50)min,P=0.011].There were no significant differences in postoperative ALT,TBIL,and serum creatinine levels on postoperative days 1 and 5,nor in the incidence of postoperative complications or hospital stay(P＞0.05).Conclusions:The application of IHIVC clamping during laparoscopic anatomic mesohepatectomy can effectively reduce central venous pressure,decrease intraoperative blood loss,and shorten operative time,without adversely affecting postoperative liver or renal function.It is a safe and effective hemodynamic control strategy,particularly suitable for complex liver resections with a high risk of bleeding.关键词
癌,肝细胞/腹腔镜检查/解剖性中肝切除术/肝下下腔静脉阻断/控制性低中心静脉压Key words
Carcinoma,hepatocellular/Laparoscopy/Anatomic mesohepatectomy/Infrahepatic inferior vena cava clamping/Controlled low central venous pressure分类
临床医学引用本文复制引用
陈熙,蒋婷,胡朝辉,罗华..肝下下腔静脉阻断技术在腹腔镜解剖性中肝切除术治疗肝细胞癌中的应用[J].腹腔镜外科杂志,2025,30(9):652-658,7.基金项目
四川省卫健委微创适宜技术基地课题(2022JDXM018) （2022JDXM018）
绵阳市卫健委科研课题(201926) （201926）
