分步阻断肝脏血流在肝门区肿瘤切除中的应用  

Application of stepped hepatic blood flow exclusion for resection of liver tumors involving hepatic hilar region

作　　者：刘江文[1] 鲁才章[1] 夏军强[1] 王奇[1] 曾勇[2] 程南生[2] 严律南[2] 

机构地区：[1]石河子人民医院普通外科,新疆石河子832000 [2]四川大学华西医院普通外科,四川成都610041

出　　处：《第四军医大学学报》2008年第1期33-35,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探讨分步肝脏血流阻断技术在肝门区肿瘤切除中的应用.方法:对采用第一肝门阻断法(Pringle法)和常温下全肝血流阻断法(THVE)相结合切除12例肝门区肿瘤的临床资料进行回顾性分析,统计肿瘤和血管的毗邻关系、阻断次数、阻断时间、术中出血量、输血量、术后并发症等指标.结果:本组Pringle法平均阻断(2.8±2.3)次,第一肝门平均阻断时间(46±31)min;THVE平均阻断(1.2±0.4)次,平均阻断时间(16±8)min;术中出血量平均(1255±366)mL,输血量平均(804±246)mL;术中修补下腔静脉4次,主肝静脉2次,门静脉主干2次;术后肝功中ALT、胆红素有不同程度升高,经治疗2～3wk后恢复正常,未发生肝功能衰竭、肝肾综合征等严重并发症,全组均痊愈出院.结论:Pringle法与TH-VE分步结合使用可增加肝门区肿瘤手术的安全性,术中B型超声对肝门区肿瘤的切除有重要的应用价值;合并有肝硬化者需慎用此法.AIM： To study the usage of stepped hepatic blood flow exclusion for resection of liver tumors involving hepatic hilar region. METHODS： The clinical data of 12 cases of liver tumors involving hepatic hilar region were retrospectively analyzed. These liver tumors were resected by combining the first hepatic portal control （Pringle maneuver） with normothermic total hepatic vascular exclusion （THVE）. These indices including the relation of liver tumors and important vessels, numbers and times of hepatic blood flow exclusion, intraoperative blood loss and blood transfusion, postoperative complications were analyzed. RESULTS： The mean numbers and times of hepatic blood flow exclusion were （2.8 ±2.3 ） and （ 46.4 ± 31.2 ） min respectively for Pringle maneuver, and were （ 1.2 ± 0.4） and （ 15.6 ± 8.3） min respectively for THVE. The mean volume of intraoperative blood loss was （ 1255 ± 366） mL, and that of blood transfusion was （804 ± 246） mL. During resections, inferior vena cave were repaired in 2 cases, main hepatic veins in 2 cases, portal veins in 2 cases. The serum alanine transaminase （ALT） and bilirubin raised by different degrees after operation, but recovered to normal level in 2- 3 weeks after treatment. No liver function failure or other serious postoperative complications were reported. All patients were cured. CONCLUSION： The technique of stepped hepatic blood flow exclusion combining Pringle maneuver with THVE can improve safety for resection of liver tumors involving hepatic bilar region. Intraoperative ultrasound plays an important role. The technique should be used cautiously in the patients with cirrhosis.

关 键 词：全肝血流阻断 肝门血流阻断 肝肿瘤 肝切除术 肝门 

分 类 号：R735.7[医药卫生—肿瘤]