Application of low central venous pressure in laparoscopic hepatectomy in patients with liver cirrhosis

doi:10.3877/cma.j.issn.2095-3232.2019.02.013

Abstract

Abstract:

Objective

To explore the application value of low central venous pressure (LCVP) technique in the laparoscopic hepatectomy in liver cirrhosis patients.

Methods

Clinical data of 95 patients with liver cirrhosis who underwent laparoscopic hepatectomy in the Fifth Affiliated Hospital of Sun Yat-sen University from March 2014 to April 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 51 patients were male and 44 female, aged 33-69 years with a median age of 44 years. The patients were divided into LCVP group (n=48) and control group (n=47) according to whether LCVP was applied during operation. In LCVP group, the central venous pressure (CVP) was maintained below 5 cmH₂O (1 cmH₂O=0.098 kPa) during liver resection. The perioperative indexes were compared between two groups by t test.

Results

In LCVP group, the liver resection time, operation time, intraoperative blood loss and intraoperative blood transfusion were (28±3) min, (132±15) min, (102±18) ml and (35±5) ml respectively, significantly less than (39±3) min, (169±19) min, (235±19) ml and (78±7) ml in control group (t=-11.34, -10.55, -35.03, -34.51; P<0.05). In LCVP group, the postoperative drainage volume, retention time of drainage tube and ALT level at postoperative 1 d were (50±9) ml, (28±10) min and (101±16) U/L, significantly less than (97±11) ml, (36±11) min and (189±19) U/L in control group (t=-22.81, -3.71, -24.44; P<0.05).

Conclusions

LCVP can reduce the volume of intraoperative bleeding, shorten the operation time, improve the postoperative liver function and safety of surgery in patients with liver cirrhosis, and it exerts no effect upon the postoperative renal function.

Key words: Central venous pressure, Hepatectomy, Laparoscopes, Liver cirrhosis

Lukun Yang, Dongyi Fan, Fangen Kong, Chaonong Cai, Jian Li. Application of low central venous pressure in laparoscopic hepatectomy in patients with liver cirrhosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(02): 139-142.

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Figures/Tables 3

References 20

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指标		LCVP组	对照组	统计值	P值
年龄（岁，±s）		45±8	45±6	t=0.18	>0.05
性别（例，男/女）		25/23	26/21	χ²=0.10	>0.05
BMI（kg/m²，±s）		20.9±1.9	21.0±2.5	t=-0.20	>0.05
肝硬化分级（例）^a				χ²=0.20	>0.05
	轻度	30	28
	中度	15	15
	重度	03	04
ASA评分（例）				χ²=0.30	>0.05
	1分	12	12
	2分	23	20
	3分	13	15
ALT（U/L，±s）		55±9	57±9	t=-1.25	>0.05
ALB（g/L，±s）		48±5	50±4	t=-1.61	>0.05
TB（μmol/L，±s）		17.7±2.9	17.8±2.8	t=-0.14	>0.05
尿素氮（mmol/L，±s）		6.5±1.1	06.3±1.3	t=0.77	>0.05
Scr（μmol/L，±s）		67±8	065±11	t=0.67	>0.05

指标		LCVP组	对照组	统计值	P值
年龄（岁，±s）		45±8	45±6	t=0.18	>0.05
性别（例，男/女）		25/23	26/21	χ²=0.10	>0.05
BMI（kg/m²，±s）		20.9±1.9	21.0±2.5	t=-0.20	>0.05
肝硬化分级（例）^a				χ²=0.20	>0.05
	轻度	30	28
	中度	15	15
	重度	03	04
ASA评分（例）				χ²=0.30	>0.05
	1分	12	12
	2分	23	20
	3分	13	15
ALT（U/L，±s）		55±9	57±9	t=-1.25	>0.05
ALB（g/L，±s）		48±5	50±4	t=-1.61	>0.05
TB（μmol/L，±s）		17.7±2.9	17.8±2.8	t=-0.14	>0.05
尿素氮（mmol/L，±s）		6.5±1.1	06.3±1.3	t=0.77	>0.05
Scr（μmol/L，±s）		67±8	065±11	t=0.67	>0.05

指标	LCVP组	对照组	t值	P值
拔管时间（min）	21±7	19±7	1.39	>0.05
引流量（ml）	50±9	97±11	-22.81	<0.05
引流管留置时间（h）	28±10	36±11	-3.71	<0.05
ALT（U/L）^a	101±16	189±19	-24.44	<0.05
ALB（g/L）^a	39±10	41±12	-0.88	>0.05
TB（μmol/L）^a	28±12	32±14	-1.50	>0.05
尿素氮（mmol/L）^a	7.8±1.4	8.1±1.6	-0.97	>0.05
Scr（μmol/L）^a	76±7	78±8	-1.30	>0.05

指标	LCVP组	对照组	t值	P值
拔管时间（min）	21±7	19±7	1.39	>0.05
引流量（ml）	50±9	97±11	-22.81	<0.05
引流管留置时间（h）	28±10	36±11	-3.71	<0.05
ALT（U/L）^a	101±16	189±19	-24.44	<0.05
ALB（g/L）^a	39±10	41±12	-0.88	>0.05
TB（μmol/L）^a	28±12	32±14	-1.50	>0.05
尿素氮（mmol/L）^a	7.8±1.4	8.1±1.6	-0.97	>0.05
Scr（μmol/L）^a	76±7	78±8	-1.30	>0.05

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