中国实用外科杂志

中国实用外科杂志

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肝下下腔静脉阻断联合入肝血流阻断在复杂肝切除术中应用

隋承军，沈伟峰，陆炯炯，戴炳华，张敏峰，杨甲梅   

  1. 第二军医大学东方肝胆外科医院特需治疗一科、肝移植科，上海200438
  • 发布日期:2012-08-29

  • Published:2012-08-29

摘要：

目的    探讨肝下下腔静脉（IVC）阻断联合入肝血流阻断（Pringle法）在复杂肝切除术中的应用价值。方法    回顾分析第二军医大学东方肝胆外科医院特需治疗一科、肝移植科2010年3月至2011年12月同一手术组收治的91例符合条件的手术病人的临床资料。结果    行Pringle法+肝下IVC阻断43例（A组），行Pringle法48例（B组）。两组的术中总出血量分别为50～1150（312.79±267.28）mL和100～1400（471.04±317.80）mL，断肝过程中出血量分别为10～300（80.70±79.77）mL和50～650（200.21±165.09）mL，A组术中总出血量及断肝过程中的出血量均明显低于B组（P<0.05）。两组阻断前的中心静脉压（CVP）无差别［（8.47±2.60）cmH2O vs. （7.94±2.30）cmH2O（1 cmH2O=0.098 kPa）］，A组阻断后的CVP明显低于B组［（1.81±2.34）cmH2O vs. （7.21±2.27）cmH2O，P<0.05］。两组术后并发症发生率差异无统计学意义，术前及术后肝肾功能比较差异无统计学意义。结论    肝下IVC阻断联合Pringle法应用在复杂肝切除术中可明显降低CVP，显著减少术中失血量。对肝肾功能无不良影响，不增加并发症的发生率和病死率。

关键词: 下腔静脉阻断, 肝切除术, 中心静脉压, 术中出血

Abstract:

Application of infrahepatic inferior vena cava clamping combined with Pringle maneuver in complex hepatectomy        SUI Cheng-jun, SHEN Wei-feng, LU Jiong-jiong, et al. Department of Special Medical Care Ⅰ and Liver Transplantation, Eastern Hepatobiliary Hospital,the Second Military Medical University, Shanghai 200438, China
Corresponding author: YANG Jia-mei, E-mail:jmyang@smmu.edu.cn
Abstract    Objective    To explore the clinical value of infrahepatic inferior vena cava(IVC) clamping combined with Pringle maneuver in complex hepatectomy. Methods    Ninety one cases who underwent hepatectomy between March 2010 and December 2011 were eligible and analyzed retrospectively.IVC clamping combined with Pringle maneuver was applied to 43 cases(group A) and Pringle maneuver alone was applied to 48 cases(group B).Data on patient demographics, surgical procedure and outcome were collected and compared between the two groups. Results    Total intraoperative blood loss (312.79±267.28 mL vs. 471.04±317.80 mL, P=0.01) and blood loss during parenchymal transaction (80.70±79.77 mL vs. 200.21±165.09 mL, P =0.00) were significantly less in group A than in group B.The CVP was 8.47±2.60 cmH2O before IVC clamping and 1.81±2.34 cmH2O after IVC clamping in group A, which decreased by 6.66 cmH2O (P<0.05). And the CVP was significantly lower in group A than in group B during parenchymal transection (1.81±2.34 cmH2O vs. 7.21±2.27 cmH2O, P<0.05). The postoperative liver and renal functions and total morbidity rates were comparable between the two groups. Conclusion    Infrahepatic IVC clamping combined with Pringle maneuver is a safe and effective technique in complex hepatectomy, which may lower the CVP and reduce intraoperative blood loss significantly.

Key words: IVC clamping, hepatectomy, central venous pressure, intraoperative blood loss