Effects Of Different Hepatic Inflow Occlusion Methods On Intestinal Mucosal Barrier Injury Of Hepatocellular Carcinoma Patients

Objective:To investigate the difference of hemihepatic inflow occlusion method between total hepatic inflow occlusion method in patients with laparoscopic hepatectomy(LH)for hepatocellular carcinoma on oxidative stress injury,intestinal mucosal barrier injury of body during perioperative period and liver recovery after surgery.Analyse the advantages and disadvantages,limitations of two hepatic inflow occlusion method.To provide evidence for hepatocellular carcinoma patients to choose hepatic inflow occlusion method which is beneficial to the prognosis of patients in LH surgery.Methods:forty adult patients with LH for hepatocellular carcinoma in the first affiliated hospital of Kunming Medical University were randomly selected.According to the different methods of hepatic inflow occlusion,patients were divided into observation group and control group.In the observation group,hemihepatic blood inflow blocking method was used to block the blood flow,the left and right hepatic arteries,left and right portal veins were isolated,the hepatectomy was performed after the the affected hepatic arteries and portal veins was blocked(20 cases);In the control group,the normal Pringle method was used to block the blood flow,the hepatectomy was performed after total hepatic blood inflow was blocked(20 cases).In two groups,controlled low central venous pressure(CLCVP)method was all applied during the process of hepatectomy,the central venous pressure(CVP)was maintained below 5 cmH20.The central venous blood was extracted 5 ml at the following time points:T1(before surgery);T2(5 min after hepatic inflow was released);T3(1 hour after hepatic inflow was released).After centrifugation of the blood samples,the isolated serum was stored in a refrigerator at-80℃.The contents of malondialdehyde(MDA),D-Lactate,diamine oxidase(DAO),and endotoxin in the isolated serum were detected.Patient’s heart rate,blood pressure,CVP at T1,T2,T3 time were recorded.The contents of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in patients’serum of two groups at 1 day before surgery and 1,3 days after surgery were also recorded after patients’ medical records were readed.The above data were statistically analysed by using SPSS23.0 software.The differences in preoperative general data(sex,age,weight,Child-Pugh grade,ASA grade),intraoperative conditions(blood pressure,CVP,MDA,D-lactate,DAO,endotoxin),postoperative liver function(AST,ALT)were compared between the two groups.Results:1.Comparison of general information,heart rate,blood pressure,CVP There was no significant difference in the general data between the two groups in sex,age,body weight,Child-Pugh grade,ASA grade(P>0.05).There was no significant difference in intraoperative heart rate,blood pressure,CVP between the two groups at T1,T2,T3 time(P>0.05).2.Comparison of MDA In the observation group,the levels of MDA at T2 and T3 time were all higher than at T1 time,the levels of MDA at T3 time was higher than at T2 time,and the difference was all statistically significant(P<0.05).In the control group,the levels of MDA at T2 and T3 time were all higher than at T1 time,the levels of MDA at T3 time was higher than at T2 time,and the difference was all statistically significant(P<0.05).The level of MDA at T1 time was no significant difference between the two groups(P>0.05).The levels of MDA at T2 and T3 time in the observation group were all lower than that in the control group,and the difference was statistically significant(P<0.05).3.Comparison of D-lactate In the observation group,the levels of D-lactate at T2 and T3 time were all higher than at T1 time,the levels of D-lactate at T3 time was lower than at T2 time,and the difference was statistically significant(P<0.05).In the control group,the levels of D-lactate at T2 and T3 time were all higher than at T1 time,the levels of D-lactate at T3 time was lower than at T2 time,and the difference was all statistically significant(P<0.05).The level of D-lactate at T1 time was no significant difference between the two groups(P>0.05).The levels of D-lactate at T2 and T3 time in the observation group were all lower than that in the control group,and the difference was statistically significant(P<0.05).4.Comparison of DAO In the observation group,the levels of DAO at T2 and T3 time were all higher than at T1 time,the levels of DAO at T3 time was higher than at T2 time,and the difference was all statistically significant(P<0.05).In the control group,the levels of DAO at T2 and T3 time were all higher than at T1 time,the levels of DAO at T3 time was higher than at T2 time,and the difference was all statistically significant(P<0.05).The level of DAO at T1 time was no significant difference between the two groups(P>0.05).The levels of DAO at T2 and T3 time in the observation group were all lower than that in the control group,and the difference was statistically significant(P<0.05).5.Comparison of endotoxin In the observation group,the levels of endotoxin at T1,T2 and T3 time were compared,and the difference was not statistically significant(P>0.05).In the control group,the levels of endotoxin at T1,T2 and T3 time were compared,and the difference was not statistically significant(P>0.05).The levels of endotoxin at T1,T2,and T3 time between the two groups was no significant difference(P>0.05)6.Comparison of ALT In the observation group,the levels of ALT at T2 and T3 time were all higher than at T1 time,the levels of ALT at T3 time was lower than at T2 time,and the difference was statistically significant(P<0.05).In the control group,the levels of ALT at T2 and T3 time were all higher than at T1 time,the levels of ALT at T3 time was lower than at T2 time,and the difference was all statistically significant(P<0.05).The level of ALT at T1 time was no significant difference between the two groups(P>0.05).The levels of ALT at T2 and T3 time in the observation group were all lower than that in the control group,and the difference was statistically significant(P<0.05).7.Comparison of AST In the observation group,the levels of AST at T2 and T3 time were all higher than at T1 time,the levels of AST at T3 time was lower than at T2 time,and the difference was statistically significant(P<0.05).In the control group,the levels of AST at T2 and T3 time were all higher than at T1 time,the levels of AST at T3 time was lower than at T2 time,and the difference was all statistically significant(P<0.05).The level of AST at T1 time was no significant difference between the two groups(P>0.05).The levels of AST at T2 and T3 time in the observation group were all lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Compared with Pringle method for hepatic inflow occlusion,hemihepatic inflow occlusion in patients with laparoscopic hepatectomy for hepatocellular carcinoma is helpful to relieve oxidative stress injury,intestinal mucosal barrier injury in perioperative and the recovery of liver function after surgery.