选择性肝血流阻断切肝术(附213例报道)  

Selective hepatic vascular exclusion in liver resections:A report of 213 cases

作　　者：周伟平[1] 李爱军[1] 傅思源[1] 单云峰[1] 唐庆贺[1] 李广罡[1] 杨远[1] 吴孟超[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院,上海200438

出　　处：《肝胆胰外科杂志》2006年第1期10-12,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的分析选择性肝血流阻断切肝术在防止术中肝脏大出血及术后肝功能衰竭方面的作用。方法根据肿瘤部位、大小及肝硬化情况,采用半肝血流阻断,半肝全血流阻断,交替半肝血流阻断,交替半肝全血流阻断,单纯门静脉阻断及肝褥式缝合等区域性肝血流阻断技术切除肝肿瘤共213例。观察肝门阻断时间、出血量、术后肝功能恢复情况及并发症发生率。结果半肝血流阻断144例,其中左肝门阻断32倒,右肝门阻断112例。半肝全血流阻断39例,其中右肝门+右肝静脉阻断26例,左肝门+左、中肝静脉阻断13例。交替半肝血流阻断7例,交替半肝全血流阻断5例,单纯门静脉阻断8例,局部褥式缝扎10例。肿瘤切除率100%, 第一肝门及肝静脉分离均成功。无一例发生肝静脉破裂出血及空气栓塞,术后无一例发生肝功能衰竭。术后胆漏6例,保守治疗痊愈。结论区域性肝血流阻断切肝术是一种安全、简便的方法,对防止肝静脉破裂出血,降低术后肝功能衰竭发生率具有重要作用。Obdective To evaluate the effects of selective hepatic vascular exclusion （SHVE） on the prevention of massive hemorrhage during hepatectomy and liver function failure after operation.Methods Hemlhepatic pedicle exclusion （HFE）, total hemihepatic vascular exclusion （THVE）, alternative hemihepatic pedicle exclusion （AHPE） , alternative total hemihepatic pedicle exclusion（ATHPE）, simple portal vein exclusion （EVE） and mattress suture were used in 213 cases according to the position and size of the tumor and the cirrhesis of the liver. The blood loss volume, vascular exclusion time, postoperative recovering situation of the liver function and the incidence of complication were observed, and mattress suture in 10 cases were performed. Results HPE was performed in 144 cases, THVE in 39 cases, AHPE in 7 cases, ATHVE in 5 cases, FVE in 8 cases and mattress suture in 10 cases. All the tumors were resected. Hemihepotic pedicle and hepatic veins were divised and exclused successfully. Massive bleeding and liver function failure didn＇t occur. Conclusion SHVE is a safe and feasible method and is effective to prevent massive bleeding of hepatic vein and to reduce the rate of liver function failure.

关 键 词：肝血流阻断 肝切除 肝肿瘤 

分 类 号：R657.3[医药卫生—外科学]