中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (01): 74-77.

• 论著 • 上一篇    下一篇

选择性半肝血流完全阻断切肝术

童颖，徐峰，阚彤，沈伟峰，谢峰，杨甲梅   

  1. 第二军医大学东方肝胆外科医院特需治疗科，上海200438
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-02 发布日期:2009-03-02

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-02 Published:2009-03-02

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摘要：

【摘要】 目的 探讨选择性半肝血流完全阻断下切肝术的临床意义。方法 回顾性分析第二军医大学东方肝胆外科医院特需治疗科2006-2007年100例因原发性肝癌行不超过半肝的规则性肝切除病人临床资料。其中35例行选择性半肝血流完全阻断切肝术（A组），余65例行全肝入肝血流阻断切肝术（B组），比较两组病人术中肝血流阻断时间、术中出血量、输血量、肝切除体积、术后肝功能恢复情况、并发症发生率等指标。结果　A组术中平均出血量及输血病人平均输血量明显少于B组（P＜0.05）。在A组肝血流阻断时间明显长于B组（P＜0.05）和两组肝切除量差异无统计学意义的情况下，A组术后第3、7d血清前白蛋白水平显著高于B组（P＜0.05），而A组术后第1、3、7d血清丙氨酸转氨酶水平均显著低于B组（P＜0.01）。术后并发症总发生率为34%，两组并发症发生率差异无统计学意义（P＞0.05）。结论　选择性半肝血流完全阻断切肝术能显著减少肝切除过程中的出血量并减轻肝功能损害。

关键词: 肝切除术, 肝血流阻断, 肝功能试验

Abstract:

Hepatectomy with selective total hemihepatic vascular occlusion TONG Ying， XU Feng，KAN Tong，et al . Department of Special Treatment， Eastern Hepatobiliary Surgery Hospital，the Second Military Medical University， Shanghai 200438， China Corresponding author：YANG Jia-mei，E-mail：lilytongy@hotmail.com Abstract Objective To explore the preliminary clinical evaluation of hepatectomy with selective total hemihepatic vascular occlusion. Methods One hundred patients with primary liver cancer that underwent regular hepatectomy not exceeding half liver in Special Treatment Department of Eastern Hepatobiliary Surgery Hospital between 2006 and 2007 were retrospectively analyzed. Thirty-five patients of them received hepatectomy with total hemihepatic vascular occlusion (group A). The other sixty-five patients received hepatectomy with total hepatic inflow occlusion (group B). The time of hepatic vascular control，intraoperative blood loss，blood transfusion, volume of removed liver，postoperative liver function recovery and complications were compared between the two groups. Results The intraoperative blood loss and blood transfusion in group A were less significantly than that in group B (P <0.05). The serum pre-albumin levels on the day 3 and 7 after operation in group A were higher significantly than that in group B (P <0.05), while the time of hepatic vascular control in group A was longer significantly than that in group B and the volume of lost liver were no difference between the groups(P＞0.05). The serum alanine aminotransferase levels on the day 1,3 and 7 after operation in group A were lower significantly than that in group B(P＜0.01). The incidence rates of postoperative complications were no difference significantly(P＞0.05). Conclusion Intraoperative blood loss during hepatectomy under the selective total hemihepatic vascular occlusion could be less and liver damage could be abated.

Key words: Keywords hepatectomy, hepatic vascular occlusion, liver function tests