Effect Of Pringle Manoeuvre On Tumor Recurrence In Patients With Primary Hepatocellular Carcinoma Resection

Objective:To investigate the effect of Pringle Manoeuvre on liver cancer recurrence and long-term survival rate,and to provide reference for rational selection of blood flow occlusion methods in clinical practice.Methods:Data of patients who underwent radical hepatocellular carcinoma resection in Jiangxi Provincial People’s Hospital and the Second Affiliated Hospital of Nanchang University from January 2014 to April 2016 were collected.Inclusion and exclusion criteria were formulated,and the selected cases were divided into groups according to whether Pringle Manoeuvre was used intraoperatively.Pringle Manoeuvre was set as the observation group(n=28),and no blood flow occlusion was set as the control group(n=12).Record each patient’s medical records,including name,gender,age,preoperative patients with Child-pugh,liver function,liver function of patients with general information,operation time,blood loss,blood transfusion,blocking blood flow to the time,block number,such as operation data,follow-up of patients with postoperative survival state,with and without recurrence,the recurrence time data and comparison.All data were analyzed using SPSS26.0 statistical software.Result:According to inclusion and exclusion criteria,a total of 40 cases were eligible for inclusion,including 28 cases(70%)in the observation group and 12 cases(30%)in the control group.There were no statistically significant differences in gender,age,BMI,hepatitis B history,preoperative AFP level,and preoperative ch ID-pugh classification of liver function between the two groups(P>0.05),indicating that the data of the two groups were comparable.In the surgical data of the two groups,the average intraoperative blood loss was183.86±92.86 ml in the observation group and 278.33± 109.95 ml in the control group.The difference between groups was statistically significant(P =0.008).There were 6cases of intraoperative blood transfusion in observation group,accounting for 21.4%;In the control group,8 patients(66.7%)received intraoperative blood transfusion.There was a significant difference in blood transfusion rate between the two groups(P=0.017).Other postoperative data and pathological data,such as operation duration,postoperative complications,number of tumors,maximum diameter of tumors,degree of differentiation,capsule presence and microvascular infiltration,showed no significant differences between groups(P >0.05).Within 5 years,the recurrence rate of the two groups was 67.8%(19 cases)in the observation group and 75.0%(9 cases)in the control group.There was no significant difference in the recurrence rate between the comparison groups(P =0.940).The tumor-free survival was 36(26.493-45.507)months in the observation group and 38(34.605-41.395)months in the control group.Combined with the 95% confidence interval,there was no significant difference in tumor-free survival between the two groups(P=0.917).Overall survival was 49(40.703-57.297)months in the observation group and 56(40.723-71.277)months in the control group.Combined with 95%confidence interval between the two groups,there was no significant difference in overall survival between the two groups(P =0.670).Conclusion:Pringle maneuver has obvious advantages in reducing intraoperative bleeding and blood transfusion rate compared with those without blood flow occlusion.Pringle maneuver had no significant effect on postoperative recurrence rate and long-term survival of HCC patients.