Study On The Effect Of Pringle Method And Hemihepatic Vascular Occlusion Method On Clinical Indicators Of Patients Undergoing Liver Tumor Resection

Objective The purpose of this study is to compare intermittent total hepatic vascular occlusion(Pringle maneuver,PM)and continuous hemihepatic vascular occlusion(HVO)on the clinical parameters of patients with liver tumor undergoing partial hepatectomy.Methods This study adopts a prospective study and selected patients with liver tumors who were hospitalized in the Department of Hepatobiliary Surgery,Affiliated Hospital of Inner Mongolia Medical University between October 2018 and October2020,and select patients who were initially diagnosed with liver tumors through strict inclusion and exclusion criteria.Including benign tumors and malignant tumors of the liver,they are subjected to routine preoperative examinations and the location of the tumors are determined through imaging methods.They are grouped according to the random number table by determining the time of the operation,and divided into PM group or HVO group,and finally total Fifty patients were enrolled,including 28 patients in the HVO group and 22 patients in the PM group.In PM group,intermittent occlusion of hepatoduodenal ligament was used to control the hepatic vascular occlusion.In HVO group,the hepatoduodenal ligament should be dissected to find and block the hepatic artery and portal vein of the affected side.During the operation,we recorded the total vascular occlusion time,blood loss,the area of the liver removed,the number of blood transfusion,and the operation time of the two groups of patients.After the operation,we recorded the liver function on the 1,3,and 7 days,and recorded the complications of the operation,the length of hospitalization,and the hospitalization expenses.The intraoperative and postoperative conditions and related clinical indicators of the PM group and HVO group were compared.Results: Comparison of the preoperative general conditions of the PM group and the HVO group,including height,weight,gender,hepatitis B prevalence,and preoperative alanine aminotransferase(ALT),aspartate aminotransferase(AST),prealbumin(PA),The statistical results of albumin(ALB),total bilirubin(TBIL)and conjugated bilirubin(DBIL)showed no significant difference(P>0.05).The intraoperative vascular occlusion time of the PM group was longer than that of the HVO group([28.5(20.0,36.8)min]vs[27.0(22.3,35.0)min]).The intraoperative hemorrhage per unit area of liver wound in the PM group was lower than that of the HVO group([ 5.4(4.0,9.9)ml/cm2]vs[7.9(4.3,13.7)ml/cm2]),the PM group is slightly shorter than the HVO group([213.1±61.6min]vs[215.6±39.6min ]),but there is no total academic difference.There were no significant differences in the amount of blood loss,the number of blood transfusions between the two groups.In terms of the incidence of postoperative complications,a total of 5(17.9%)patients in the HVO group had problems such as incision infection,pleural and ascites,and lung infection,while a total of 7(31.8%)patients in the PM group had postoperative related complications,and there were Two patients suffered severe liver and kidney dysfunction after surgery due to massive blood loss during the operation,but the statistical analysis of the incidence of the two groups of patients after surgery was not significant(P>0.05).In the comparison of postoperative liver function between the two groups,there was no significant difference in PA,ALB,TBIL,and DBIL between the two groups at 1,3,and 7 days after surgery(P>0.05).The levels of ALT and AST of the patients on the first 1,3,and 7 days after operation were significantly lower in the HVO group than in the PM group,and they were all statistically significant(P<0.05),and in the comparison of postoperative hospitalization expenses and hospitalization time,the above results are also obtained(P<0.05).At the same time,we separately compared the patients with hemihepatectomy in the two groups and found that the liver function indexes(TBIL,DBIL)of the HVO group were higher than those of the PM group before surgery.The comparison of TBIL between PM group and HVO group was([13.4(12.3,26.9)umol/L]vs[23.7(19.9,79.2)umol/L]),Compared with DBIL,it is([6.7(5.2,11.3)umol/L]vs[12.0(9.5,41.7)umol/L]),In the comparison of other clinical indicators,it is consistent with the conclusions drawn from the previous comparison of PM group and HVO group.Conclusion: In liver resection for liver tumors,HVO and PM are safe and feasible regardless of the scope of liver resection.The HVO method significantly reduces liver damage by preserving the normal blood supply of the contralateral liver,accelerates the recovery of liver function after surgery,reduces the incidence of surgical complications,and reduces the length of hospitalization and hospitalization costs for patients.