The relevant data of 220 patients undergoing laparoscopic hepatectomy in our hospital were collected. Based on randomization, blindness and inclusion and exclusion criteria, the patients were divided into group A (which included Pringle method + restricted fluid management + vasoactive drug use by anesthesiologists) and group B (which included: Pringle method +IVC flow limiting and blocking method, intraoperative fluid rehydration according to physiological requirements and expected loss, no or less vasoactive drugs used during the operation), and intraoperative and postoperative relevant indicators were compared between the two groups, such as; CVP value, fluctuation range, length of operation, time of liver amputation, total blood loss, amount of liver amputation, amount of blood transfusion, and amount of fluid perfusion. Internal environmental indicators: albumin, alanine aminotransferase, aspartate aminotransferase, γ-gt, total bilirubin, renal function, lactic acid, blood gas analysis (three times during the operation). Postoperative indexes: average length of stay and unplanned reoperation rate. While taking into account the safety, effectiveness and interpretability of statistical results, a new laparoscopic hepatectomy technique based on the optimized CLCVP process was constructed to control intraoperative bleeding and GDFT standardized and streamlined intervention strategy. This is not only an important innovation of the CLVCP concept, but also an important link to accelerate the implementation of laparoscopic liver resection technology in grassroots hospitals, and will significantly improve the quality of medical services, which can bring more accurate and efficient treatment programs to patients.
Preoperative Child-Pugh classification of liver function Grade A and grade B;
No contraindications for laparoscopic hepatectomy;
Liver diseases include: primary liver cancer, hepatic hemangioma, intrahepatic bile duct calculus, intrahepatic bile duct cell carcinoma, etc.
Patients voluntarily participate and sign informed consent;
Poor liver reserve function, ICG retention rate > 15%;
severe heart and lung diseases, unable to tolerate general anesthesia surgery;
Previous history of liver surgery;
hepatic encephalopathy;
Parallel
In laparoscopic hepatectomy, the subhepatic inferior vena cava was restricted and the patient was given non-restricted intraoperative fluid intake
Procedure/SurgeryThe specific steps of IVC blocking were performed by the principal physician under laparoscopic operation: slightly incision of the posterior peritoneum on both sides of the inferior vena cava above the level of the renal vein. The "blood vessel blocking band" is passed behind the inferior vena cava on the left or right side of the inferior vena cava. According to the intraoperative situation, the blocking band (flow limiting blocking/incomplete blocking of subhepatic inferior vena cava) was tightened to control the bleeding from hepatic vein on the liver section. Patients in this group did not use vasoactive drugs/underuse means to control CVP, so they need to strictly communicate with the anesthesiologist, and take the fluid intake based on the physiological requirements and fluid loss of individual patients (cancel the restriction of fluid intake).
Intraoperative blood loss
The amount of intraoperative blood loss is an important index to evaluate surgical safety
Intraoperative central venous pressure
Central venous pressure is an important factor in the evaluation of blood loss after subhepatic inferior vena cava occlusion
Level of aminotransferase
An important indicator of liver function
level of Lactic acid
An important indicator of liver and kidney metabolic function
Blood Sugar level
An important indicator of liver synthesis
level of creatinine
An important indicator of kidney function
Postoperative complications, such as bile leakage, laparoscopic infection, deep vein thrombosis of the lower extremity, and unplanned re-entry surgery
Indicators to evaluate postoperative safety
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