切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (06) : 538 -542. doi: 10.3877/cma.j.issn.2095-3232.2020.06.009

所属专题： 文献；

临床研究

腹腔镜肝癌切除术中CVP与出血量关系及其影响因素
李文轩1, 潘扬勋1, 侯嘉杰1, 侯靖禹1, 陆霄云2, 赖仁纯2, 王小辉1, 王骏成1, 徐立1, 张耀军1, 陈敏山1, 周仲国1,†()   
  1. 1. 510060　广州，华南肿瘤学国家重点实验室　肿瘤医学协同创新中心　中山大学肿瘤防治中心肝脏外科
    2. 510060　广州，华南肿瘤学国家重点实验室　肿瘤医学协同创新中心　中山大学肿瘤防治中心麻醉科
  • 收稿日期:2020-07-06 出版日期:2020-12-10
  • 通信作者: 周仲国
  • 基金资助:
    白求恩公益基金(HZB20181119); 中山大学肿瘤防治中心医师科学家基金(16zxqk04)

Relationship between central venous pressure and blood loss in laparoscopic hepatectomy for liver cancer and its influencing factors

Wenxuan Li1, Yangxun Pan1, Jiajie Hou1, Jingyu Hou1, Xiaoyun Lu2, Renchun Lai2, Xiaohui Wang1, Juncheng Wang1, Li Xu1, Yaojun Zhang1, Minshan Chen1, Zhongguo Zhou1,†()   

  1. 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
    2. Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  • Received:2020-07-06 Published:2020-12-10
  • Corresponding author: Zhongguo Zhou
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李文轩, 潘扬勋, 侯嘉杰, 侯靖禹, 陆霄云, 赖仁纯, 王小辉, 王骏成, 徐立, 张耀军, 陈敏山, 周仲国. 腹腔镜肝癌切除术中CVP与出血量关系及其影响因素[J]. 中华肝脏外科手术学电子杂志, 2020, 09(06): 538-542.

Wenxuan Li, Yangxun Pan, Jiajie Hou, Jingyu Hou, Xiaoyun Lu, Renchun Lai, Xiaohui Wang, Juncheng Wang, Li Xu, Yaojun Zhang, Minshan Chen, Zhongguo Zhou. Relationship between central venous pressure and blood loss in laparoscopic hepatectomy for liver cancer and its influencing factors[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(06): 538-542.

目的

探讨腹腔镜肝癌切除术中中心静脉压（CVP）与出血量的关系及其影响因素。

方法

回顾性分析2017年9月至2018年9月在中山大学肿瘤防治中心行腹腔镜肝癌切除术的137例患者临床资料。其中男116例，女21例；年龄23～79岁，中位年龄55岁。患者均签署知情同意书，符合医学伦理学规定。根据术中出血量将患者分为术中出血量≤200 ml组和术中出血量>200 ml组。两组术中CVP比较采用t检验，CVP相关影响因素分析采用多重线性回归分析。

结果

术中出血量>200 ml组断肝前CVP、断肝期间CVP、断肝前后CVP差值（ΔCVP）分别为（12±5）、（7±4）、（5±4）cmH2O，明显高于术中出血量≤200 ml组的（8±6）、（5±4）、（3±4）cmH2O（t=3.823，2.289，2.680；P<0.05）。回归分析显示，硝酸甘油维持剂量与断肝前CVP的关系最大（t=4.496，P<0.05），术中出血量、硝酸甘油维持剂量与断肝期间CVP的关系最大（t=3.008，2.355；P<0.05），气道峰压、硝酸甘油维持剂量与ΔCVP的关系最大（t=3.017，2.664；P<0.05）。

结论

腹腔镜肝切除术术中出血量与CVP相关，通过调节硝酸甘油维持剂量、气道峰压可以维持腹腔镜肝切除术中低CVP水平，有助于减少术中出血，提高手术安全性。

关键词: 肝肿瘤, 腹腔镜, 肝切除术, 中心静脉压, 失血, 手术
Objective

To explore the relationship between central venous pressure (CVP) and blood loss in laparoscopic hepatectomy for liver cancer and to identify its influencing factors.

Methods

Clinical data of 137 patients who underwent laparoscopic hepatectomy in Sun Yat-sen University Cancer Center from September 2017 to September 2018 were retrospectively analyzed. Among them, 116 patients were male and 21 female, aged from 23 to 79 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to intraoperative blood loss, all patients were divided into the ≤200 ml and >200 ml groups. Intraoperative CVP was statistically compared between two groups by using t test. The influencing factors of CVP were identified by multiple linear regression analysis.

Results

In the intraoperative blood loss > 200 ml group, CVP before liver resection, CVP during liver resection, and ΔCVP (the difference between CVP before and after liver resection) were (12±5), (7±4) and (5±4) cmH2O, significantly higher than (8±6), (5±4) and (3±4) cmH2O in the intraoperative blood loss ≤200 mlgroup (t=3.823, 2.289, 2.680; P<0.05). Regression analysis showed that nitroglycerin maintenance dose was the most significantly correlated with the CVP before liver resection (t=4.496, P<0.05). Intraoperative blood loss, nitroglycerin maintenance dose were the most significantly correlated with the CVP during liver resection (t=3.008, 2.355; P<0.05). The peak airway pressure and nitroglycerin maintenance dose were the most significantly correlated with ΔCVP (t=3.017, 2.664; P<0.05).

Conclusions

The blood loss during laparoscopic hepatectomy is correlated with CVP. The low CVP level can be maintained by adjusting nitroglycerin maintenance dose and airway pressure during laparoscopic hepatectomy, which contributes to reducing intraoperative bleeding and improving surgical safety.

Key words: Liver neoplasms, Laparoscopes, Hepatectomy, Central venous pressure, Blood loss, surgical
表1 137例腹腔镜肝癌切除术不同术中出血量组患者一般资料比较
组别 例数 性别（男/女） 年龄[岁，M(QR)] BMI[kg/m2, M(QR)] ALT(U/L，±s) ALB(g/L，±s) TB(μmol/L，±s) Scr(μmol/L，±s)
术中出血量≤200 ml组 76 63/13 55(17) 23(5) 35±27 44±3 14±6 75±16
术中出血量>200 ml组 61 53/8 55(13) 23(4) 38±28 44±3 12±4 74±16
统计值   χ2=0.415 Z=0.780 Z=1.057 t=-0.569 t=0.210 t=1.542 t=0.253
P值   0.519 0.435 0.291 0.570 0.834 0.125 0.800
表2 137例腹腔镜肝癌切除术不同术中出血量组患者CVP影响因素回归分析
变量 断肝期前CVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 8.550 0.534   16.007 <0.001
硝酸甘油维持剂量 5.811 1.292 0.361 4.496 <0.001
变量 断肝期间CVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 4.263 0.473   9.011 <0.001
术中出血量 0.003 0.001 0.247 3.008 0.003
硝酸甘油维持剂量 2.175 0.923 0.193 2.356 0.020
变量 ΔCVP
偏回归系数 标准误 标准偏回归系数 t值 P值
常数项 -2.654 2.059   -1.289 0.200
气道峰压 0.332 0.110 0.248 3.017 0.003
硝酸甘油维持剂量 2.744 1.030 0.219 2.664 0.009
[1]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2]
Cheng S, Chen M, Cai J, et al. Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus (2018 edition)[J]. Liver Cancer, 2020, 9(1):28-40.
[3]
Li L, Wang H. Heterogeneity of liver cancer and personalized therapy[J]. Cancer Lett, 2016, 379(2):191-197.
[4]
Jin B, Chen MT, Fei YT, et al. Safety and efficacy for laparoscopic versus open hepatectomy: a meta-analysis[J]. Surg Oncol, 2018, 27(2):A26-34.
[5]
Tsinberg M, Tellioglu G, Simpfendorfer CH, et al. Comparison of laparoscopic versus open liver tumor resection: a case-controlled study[J]. Surg Endosc, 2009, 23(4):847-853.
[6]
Cheung TT, Poon RT, Yuen WK, et al. Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience[J]. Ann Surg, 2013, 257(3):506-511.
[7]
Kim H, Suh KS, Lee KW, et al. Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case-controlled study with propensity score matching[J]. Surg Endosc, 2014, 28(3):950-960.
[8]
Karaaslan P, Gokay BV, Karakaya MA, et al. Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter[J]. Ann Saudi Med, 2017, 37(4):308-312.
[9]
Zatloukal J, Pradl R, Kletecka J, et al. Comparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery:a randomized controlled trial[J]. Minerva Anestesiol, 2017, 83(10): 1051-1060.
[10]
Hughes MJ, Ventham NT, Harrison EM, et al. Central venous pressure and liver resection: a systematic review and meta-analysis[J]. HPB, 2015, 17(10):863-871.
[11]
Moggia E, Rouse B, Simillis C, et al. Methods to decrease blood loss during liver resection: a network meta-analysis[J]. Cochrane Database Syst Rev, 2016(10):Cd010683.
[12]
Correa-Gallego C, Berman A, Denis SC, et al. Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases[J]. HPB, 2015, 17(3):258-264.
[13]
Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy[J]. Ann Surg, 2016, 263(6):1159-1163.
[14]
Schroeder RA, Collins BH, Tuttle-Newhall E, et al. Intraoperative fluid management during orthotopic liver transplantation[J].J Cardiothorac Vasc Anesth, 2004, 18(4):438-441.
[15]
Aghayan DL, Kalinowski P, Kazaryan AM, et al. Laparoscopic liver resection for non-colorectal non-neuroendocrine metastases: perioperative and oncologic outcomes[J]. World J Surg Oncol, 2019, 17(1):156.
[16]
Aldrighetti L, Ratti F, Cillo U, et al. Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry[J]. Updates Surg, 2017, 69(3):271-283.
[17]
Li Z, Sun YM, Wu FX, et al. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy[J]. World J Gastroenterol, 2014, 20(1):303-309.
[18]
Cheng ES, Hallet J, Hanna SS, et al. Is central venous pressure still relevant in the contemporary era of liver resection?[J]. J Surg Res, 2016, 200(1):139-146.
[19]
Gagner M, Rogula T, Selzer D. Laparoscopic liver resection: benefits and controversies[J]. Surg Clin North Am, 2004, 84(2):451-462.
[20]
Kaneko H. Laparoscopic hepatectomy: indications and outcomes[J]. J Hepatobiliary Pancreat Surg, 2005, 12(6):438-443.
[21]
Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections[J]. Am J Surg, 2004, 187(3):398-402.
[22]
曹枫，刘先福，陈荣琳，等．呼气末正压对机械通气患者中心静脉压及髂总静脉压的影响[J]．中国危重病急救医学，2008, 20(6): 341-344.
[23]
Shojaee M, Sabzghabaei A, Alimohammadi H, et al. Effect of positive end-expiratory pressure on central venous pressure in patients under mechanical ventilation[J]. Emerg, 2017, 5(1):e1.
[1] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[2] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[3] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[4] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[11] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[12] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[13] 纪凯伦, 郝少龙, 孙海涛, 韩威. 减重术后胆囊结石形成机制的新进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 100-103.
[14] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[15] 程相阵. 腹茧症9例诊治分析并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(9): 968-971.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号