Analysis of the causes of abdominal distension after laparoscopic hepatectomy for hepatocellular carcinoma and treatment countermeasures_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUE Gaohui ¹ , HAO Yongli ¹ , SU Lan ² , TANG Hongmei ¹ , FENG Lei ³ ,  LUO Yanli ¹

1. Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu, P. R. China;
2. Anesthesia Surgery Center, Shangjin Branch, West China Hospital, Sichuan University, Chengdu, P. R. China;
3. Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, P. R. China;

Corresponding?author：

LUO Yanli, Email: Luoyl6@126.com

Keywords：

hepatocellular carcinoma; laparoscopy; hepatectomy; abdominal distension; prevention and treatment

DOI：

10.7507/1007-9424.202112087

Video：

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Objective To study the causes of abdominal distension in patients with hepatocellular carcinoma (HCC) after laparoscopic hepatectomy, and to explore the corresponding treatment countermeasures. Methods A total of 186 patients with HCC were treated by laparoscopic hepatectomy in our hospital from September 1, 2018 to August 31, 2020. Demographic characteristics [age, gender, body mass index (BMI), liver cirrhosis, child-Pugh classification of liver function], operative time, hilar occlusion time, intraoperative blood loss, scope of hepatectomy, postoperative visual analogue scale (VAS) score and serological indexes (hemoglobin, serum albumin, white blood cell count, platelet count, serum potassium level) were collected retrospectively. The occurrence of postoperative abdominal distension was observed, and the patients were divided into abdominal distension group and non abdominal distension group. The independent influencing factors of abdominal distension after laparoscopic hepatectomy were analyzed, and the corresponding treatment countermeasures were discussed. Results A total of 138 patients developed varying degrees of abdominal distension after operation (74.19%), including 45 cases of mild abdominal distension, 53 cases of moderate abdominal distension, and 40 cases of severe abdominal distension. They were all included in the abdominal distension group, and the occurrence time of abdominal distension was mainly 1-5 days after operation. Forty-eight patients (25.81%) had no abdominal distension after operation and were included in the non-abdominal distension group. Univariate analysis results show that: the proportion of patients with abdominal distension combined with liver cirrhosis was significantly higher than that of the non-abdominal distension group (47.10% vs. 25.00%, P=0.007), the operative time [(143.54±23.48) min vs. (129.45±24.51) min, P=0.001], hilar occlusion time [(18.02±8.12) min vs. (15.38±7.28) min, P=0.048] were significantly longer than those of the non-abdominal distension group, the postoperative VAS score was significantly higher than that of the non-abdominal distension group [5.12±1.14 vs. 4.47±1.05, P=0.004], and the serum potassium level was significantly lower than that of the non-abdominal distension group [(3.12±0.38) mmol/L vs. (3.67±0.42) mmol/L, P＜0.001]. Multivariate unconditional logistic regression analysis showed that patients with liver cirrhosis [OR=1.520, 95%CI (1.104, 2.093), P=0.010], serum potassium level ＜3.40 mmol/L [OR=1.684, 95%CI (1.203, 2.357) , P=0.002], operative time ＞136 min [OR=1.842, 95%CI (1.297, 2.616) , P=0.001], hilar occlusion time ＞16.7 min [OR=1.492, 95%CI (1.047, 2.126) , P=0.027], VAS score ＞5 [OR=1.498, 95%CI (1.021, 2.198), P=0.039] were independent risk factors of abdominal distension after laparoscopic hepatectomy. Conclusions The risk factors of abdominal distension after laparoscopic hepatectomy were liver cirrhosis, serum potassium level ＜3.40 mmol/L, operative time ＞136 min, hilar occlusion time ＞16.7 min and VAS score ＞5. More attention should be paid to high-risk patients and effective treatment measures should be taken in time to reduce the risk of abdominal distension after surgery. For patients with abdominal distension, we should take effective measures to alleviate the symptoms of abdominal distension and promote the recovery of patients with abdominal distension.

Citation： YUE Gaohui, HAO Yongli, SU Lan, TANG Hongmei, FENG Lei, LUO Yanli. Analysis of the causes of abdominal distension after laparoscopic hepatectomy for hepatocellular carcinoma and treatment countermeasures. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(6): 774-778. doi: 10.7507/1007-9424.202112087 Copy

1.	Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
2.	Lacy BE, Cangemi D, Vazquez-Roque M. Management of chronic abdominal distension and bloating. Clin Gastroenterol Hepatol, 2021, 19(2): 219-231.
3.	于海龍, 于志國, 白雪峰. 大承氣湯治療結腸癌術后患者腹脹125例臨床觀察. 中醫藥信息, 2012, 29(6): 75-77.
4.	奚曉華, 丁根樹, 張文博, 等. 改良復方大承氣湯治療粘連性腸梗阻與一氧化氮變化的關系. 江西醫藥, 2014, 49(11): 1149-1153.
5.	Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10 811 patients. Br J Anaesth, 2000, 84(1): 6-10.
6.	張德耀, 陳敏山. 《2021年歐洲腫瘤內科學會肝細胞癌臨床實踐指南更新》解讀. 中國醫學前沿雜志(電子版). 2021, 13(8): 1-4.
7.	吳曙霞, 林巧琴. ERAS理念下的術后管理在肝癌肝切除術后護理及對患者VAS評分的影響. 中華腫瘤防治雜志, 2018, 25(S2): 193-194.
8.	Svedlund J, Sj?din I, Dotevall G. GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci, 1988, 33(2): 129-134.
9.	Garrido A, Djouder N. Cirrhosis: a questioned risk factor for hepatocellular Carcinoma. Trends Cancer, 2021, 7(1): 29-36.
10.	Kalaitzakis E. Gastrointestinal dysfunction in liver cirrhosis. World J Gastroenterol, 2014, 20(40): 14686-14695.
11.	Spencer RP. Potassium metabolism and gastrointestinal function; a review; a semiquantitative approach. Am J Dig Dis, 1959, 4(2): 145-158.
12.	Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
13.	Gurusamy KS, Sheth H, Kumar Y, et al. Methods of vascular occlusion for elective liver resections. Cochrane Database Syst Rev, 2009, (1): Cd007632. doi:10.1002/14651858. CD007632.
14.	景冠達, 劉雨薇, 胡艷杰, 等. 加速康復外科在肝細胞癌肝切除術患者中的應用效果與費用分析. 中國普外基礎與臨床雜志, 2021, 28(11): 1434-1438.
15.	鄭春曉, 鄭亦胡, 謝少華. 快速康復外科護理模式在腹腔鏡肝癌切除術圍手術期的應用. 肝膽胰外科雜志, 2017, 29(6): 502-504.
16.	蔣梅, 周岱翰, 郭然, 等. 姜橘暖胃膏穴位貼敷聯合托烷司瓊和地塞米松預防化療所致惡心嘔吐的臨床療效研究. 中國全科醫學, 2020, 23(16): 2051-2056.
17.	羅堅女, 金國軍. 足三里穴位按摩對腹部手術后腸功能恢復的療效觀察. 中華中醫藥雜志, 2020, 35(3): 1611-1612.

1. Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
2. Lacy BE, Cangemi D, Vazquez-Roque M. Management of chronic abdominal distension and bloating. Clin Gastroenterol Hepatol, 2021, 19(2): 219-231.
3. 于海龍, 于志國, 白雪峰. 大承氣湯治療結腸癌術后患者腹脹125例臨床觀察. 中醫藥信息, 2012, 29(6): 75-77.
4. 奚曉華, 丁根樹, 張文博, 等. 改良復方大承氣湯治療粘連性腸梗阻與一氧化氮變化的關系. 江西醫藥, 2014, 49(11): 1149-1153.
5. Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10 811 patients. Br J Anaesth, 2000, 84(1): 6-10.
6. 張德耀, 陳敏山. 《2021年歐洲腫瘤內科學會肝細胞癌臨床實踐指南更新》解讀. 中國醫學前沿雜志(電子版). 2021, 13(8): 1-4.
7. 吳曙霞, 林巧琴. ERAS理念下的術后管理在肝癌肝切除術后護理及對患者VAS評分的影響. 中華腫瘤防治雜志, 2018, 25(S2): 193-194.
8. Svedlund J, Sj?din I, Dotevall G. GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci, 1988, 33(2): 129-134.
9. Garrido A, Djouder N. Cirrhosis: a questioned risk factor for hepatocellular Carcinoma. Trends Cancer, 2021, 7(1): 29-36.
10. Kalaitzakis E. Gastrointestinal dysfunction in liver cirrhosis. World J Gastroenterol, 2014, 20(40): 14686-14695.
11. Spencer RP. Potassium metabolism and gastrointestinal function; a review; a semiquantitative approach. Am J Dig Dis, 1959, 4(2): 145-158.
12. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
13. Gurusamy KS, Sheth H, Kumar Y, et al. Methods of vascular occlusion for elective liver resections. Cochrane Database Syst Rev, 2009, (1): Cd007632. doi:10.1002/14651858. CD007632.
14. 景冠達, 劉雨薇, 胡艷杰, 等. 加速康復外科在肝細胞癌肝切除術患者中的應用效果與費用分析. 中國普外基礎與臨床雜志, 2021, 28(11): 1434-1438.
15. 鄭春曉, 鄭亦胡, 謝少華. 快速康復外科護理模式在腹腔鏡肝癌切除術圍手術期的應用. 肝膽胰外科雜志, 2017, 29(6): 502-504.
16. 蔣梅, 周岱翰, 郭然, 等. 姜橘暖胃膏穴位貼敷聯合托烷司瓊和地塞米松預防化療所致惡心嘔吐的臨床療效研究. 中國全科醫學, 2020, 23(16): 2051-2056.
17. 羅堅女, 金國軍. 足三里穴位按摩對腹部手術后腸功能恢復的療效觀察. 中華中醫藥雜志, 2020, 35(3): 1611-1612.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the causes of abdominal distension after laparoscopic hepatectomy for hepatocellular carcinoma and treatment countermeasures

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