Evaluation of the Safety and Effectiveness of Pringle Method Combined With IVC Flow Limiting and Blocking Method in Laparoscopic Hepatectomy Based on Non-restrictive Fluid Therapy Strategy

Overall design Research hypothesis: Based on the non-restrictive fluid management strategy (intraoperative fluid rehydration according to physiological requirements and expected loss, no or less use of vasoactive drugs during the operation) combined with Pringle method and IVC flow restriction blocking method, the method of blocking hepatic blood flow was applied to effectively control intraoperative bleeding. Reduce the degree of intraoperative anesthesiologist dependence, improve the intraoperative compatibility between surgeons and anesthesiologists, and optimize the traditional CLVCP process, so as to achieve the goal of accurate maintenance of patients' organs in functional surgery and more rapid and widespread promotion of laparoscopic liver resection technology.

Type of study: A prospective randomized controlled study will be used in this study 5.2 Research and design process 5.2.1 Study the specific implementation process A total of 220 patients undergoing elective laparoscopic partial hepatectomy were selected from our hospital. All patients and their families knowingly and voluntarily signed informed consent before enrollment. On the basis of randomization and inclusion and exclusion criteria, the patients were divided into group A (110 cases) (Pringle method + restricted fluid management + use of vasoactive drugs by anesthesiologists) and group B (110 cases) (Pringle method +IVC flow restriction blocking + open fluid intake during the operation, and no/less use of vasoactive drugs during the operation). Intraoperative and postoperative related indexes were compared between the two groups, such as; CVP value, duration, fluctuation range, length of operation, time of liver amputation, total blood loss, amount of liver amputation, amount of blood transfusion, amount of liquid perfusion, three blood gas analysis during the operation, blood glucose, and dosage of vasoactive drugs. 3 days after operation: albumin, alanine aminotransferase, aspartate aminotransferase, gamma-GT, total bilirubin, renal function, lactic acid and other related indexes. Postoperative hospital stay (d), tracheal intubation and extubation time (d), surgical cost (ten thousand yuan), abdominal effusion, pulmonary infection, postoperative flatulence time (d), postoperative exhaust time (d), incision infection, intestinal obstruction. To comprehensively evaluate the safety and efficacy of Pringle method and IVC flow limiting blockade in the implementation of non-restrictive fluid intake strategies.

Ways to reduce bias

1. Complete random grouping: This study adopts the complete random grouping method; Patients meeting the inclusion criteria were assigned to group A and Group B in a 1:1 ratio with 110 cases in each group by random number table method. The results are hidden in an opaque sealed envelope, which is then stored by the clinical study designer (i.e., a random code sheet). The researcher opened the envelope on the morning of the operation to obtain the group of patients and informed the operating physician and anesthesiologist to intervene accordingly according to the study protocol.
2. Baseline control of patients Group A (Pringle method + restricted fluid management + use of vasoactive drugs by anesthesiologists) : The means of use and anesthetic drugs in this group were all conventional technical means without special intervention, so it was the control group.

Group B (Pringle method +IVC flow limiting and blocking method + open fluid intake during operation; Observation group: Patients in this group did not use anesthesia related drugs to control CVP, so they should strictly communicate with the anesthesiologist, and achieve homogeneity in the use of vasoactive drugs and narcotic drugs.