常温下连续阻断半肝血流60min在乙肝肝硬变患者肝切除术中的应用  

Continuous Normothermic Hemihepatic Vascular Inflow Occlusion over 60 Min for Hepatectomy in Patients with Cirrhosis Caused by Hepatitis B Virus

作　　者：梁冠林[1] 陈哲宇[1] 文天夫[1] 严律南[1] 李波[1] 曾勇[1] 吴国长[1] 郑光琪[1] 张宇[1] 张显华[1] 李国[1] 

机构地区：[1]四川大学华西医院普外二科,成都610041

出　　处：《中国普外基础与临床杂志》2008年第7期503-507,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省应用基础研究基金(编号:O5SY029-005-3)~~

摘　　要：目的评价常温下连续阻断半肝血流60min行不规则肝切除术对乙肝肝硬变患者剩余肝脏安全性的影响。方法回顾性分析1995年1月至2006年12月在华西医院施行半肝血流阻断肝切除术的232例乙肝肝硬变伴有肝细胞癌患者的临床资料。依据半肝血流阻断时间将患者分成3组:<60min组、60～90min组和>90min组;分析3组患者术中的出血量、输血量、肝脏功能和术后并发症发生情况。结果3组术后并发症发生情况比较差异无统计学意义(P>0.05)。3组患者的AST、ALT、PT和总胆红素水平在术后第1和3d较术前均显著升高(P<0.05),于术后第7d则明显下降并接近术前水平;白蛋白水平和血小板计数在术后第1d较术前均显著下降(P<0.05),于术后第3和7d则明显升高并接近术前水平。>90min组的住院时间、ALT和AST水平均高于<60min组和60～90min组(P<0.05),而后2组间差异则无统计学意义(P>0.05)。结论半肝血流阻断法在乙肝肝硬变不规则肝切除术中具有可行性和一定的安全性;当半肝血流阻断时间>90min时,使用该方法应慎重。Objective To evaluate the safety of remnant liver in cirrhotic patients who had undergone irregular hepatectomy with continuous normothermic hemihepatic vascular inflow occlusion over 60 min. Methods Clinical data of 232 cirrhotic patients who had hepatitis B virus accompanied by hepatocellular carcinoma and had undergone irregular hepatectomy by hemihepatic vascular inflow occlusion was studied. According to the time of hemihepatic vascular inflow occlusion, patients were assigned to the （60 min group, 60-90 min group, and 〉90 min group. The quantity of blood loss and blood transfusion, routine liver biochemistry and postoperative complications were retrospectively analyzed. Results The data showed that there were no significant differences in postoperative complications among the three groups （P〉0.05）. Compared with the preoperative day, the levels of AST, ALT, PT and TB on postoperative day 1 and 3 were significantly increased in three groups and the levels of albumin and platelet were significantly decreased on postoperative day 1. Duration of hospital stay and the levels of ALT and AST on postoperative day 1, 3 and 7 in the 〉90 min group were higher than those in the 〈60 min group and 60--90 min group （P〈0.05）. However, no significant difference was displayed in the length of hospital stay and the levels of AST, ALT, PT, albumin, platelet count and serum total bilirubin on postoperative day 1, 3 and 7 between the （ 60 min group and the 60--90 min group （P〉0.05）. Conclusion Hemihepatic vascular inflow occlusion over 60 min is a feasible method and safe to a certain extent for irregular hepatectomy in patients with cirrhosis caused by the hepatitis B virus. However, caution must be exercised in utilizing this method when the time of vascular occlusion is over 90 min.

关 键 词：半肝血流阻断 肝叶切除术 肝硬变 PRINGLE法 

分 类 号：R657.3[医药卫生—外科学]