原发性肝癌肝切除术中延长肝门阻断时限的探讨  

Extended hepatic pedicle ocdusion in major hepatectomy for primary liver cancer

作　　者：王义[1] 陈科济[1] 张友磊[1] 孙延富[1] 尉公田[1] 胡雷[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海200438

出　　处：《中华外科杂志》2008年第10期776-779,共4页Chinese Journal of Surgery

摘　　要：目的探讨原发性肝癌肝切除术中延长肝门阻断时限对手术失血量和肝功能的影响。方法回顾性总结2001年6月至2005年12月原发性肝癌肝切除术中一次肝门阻断时间≥30min患者的临床资料（持续阻断组），并以累积肝门阻断时间在相同范围内但为常规间歇性阻断的患者作为对照（间歇阻断组），比较两组手术失血量、接受输血病例的比例以及术后肝功能恢复情况。结果持续阻断组共35例，间歇阻断组共38例，两组患者临床资料比较无明显差异（P〉0．05）；持续阻断组平均肝门阻断时间为（34．7±4．4）min（30—45min），间歇阻断组为（35．3±4．2）min，两者差异无统计学意义（P〉0．05）；持续阻断组平均手术失血量为（660．0±655．8）ml，显著少于间歇阻断组的（1054．0．±673．3）ml（P〈0．05），接受输血患者的比例（48．6％）也显著低于间歇阻断组（78．9％）（P〈0．01）；两组患者术后肝功能均顺利恢复，术后并发症的发生率无明显差异（P〉0．05）。结论在肝功能代偿良好的复杂原发性肝癌肝切除术中肝门阻断时间可以持续30—45min，与常规的间歇性阻断相比未增加对肝脏的损伤，但显著减少了手术失血量、降低了需要输血患者的比例。Objective To evaluate the influence of extended hepatic pedicle occlusion（HPO） on hepatic ischemic/reperfusion （I/R） injury and intraoperative blood loss in major hepatectomy for primary liver cancer （PLC）. Methods Between June 2001 and December 2005, a total number of 843 patients with PLC had been operated on. Those whose hepatic pedicle were occluded continuously for or longer than 30 min during hepatectomy were retrospectively reviewed （ continuous HPO group ） and compared to the patients whose hepatic pedicle were occluded for the same length of time but intermittently （ intermittent HPO group）. The amount of intraoperative blood loss, the percentage of the patients who needed blood transfusion and postoperative liver biochemical tests were compared between the two groups. Results There were 35 cases in continuous HPO group and 38 cases in intermittent HPO group with occlusion time between 30 min and 45 min. The two groups were matched for underlying liver disease, preoperative liver function,tumor size and location, major intrahepatic vessel involvements and the types and extensions of the hepatectomies. The mean intraoperative blood loss in continuous HPO group was significantly less than that in intermittent HPO group （660 ml vs. 1054 ml,P 〈0. 05） ;accordingly,the percentage of patients who need blood transfusion in countinuous HPO group was significantly lower than that in intermittent HPO group （48.6% vs. 78.9% ,P 〈 0. 01 ）. Patients in both of the groups were recovered smoothly after operation,with no occurrence of liver failure. Conclusions The hepatic pedicle can be continuously occluded for 30-45 min in cirrhotic patients with well compensated liver function, and when compared to routine intermittent HPO, continuous HPO significantly decreases the intraoperative blood loss and reduces the need for transfusion. Meanwhile it does not increase the hepatic I/R injury.

关 键 词：肝切除术 肝肿瘤 失血 手术 

分 类 号：R686[医药卫生—骨科学]