选择性与全肝人肝血流阻断法在肝切除术应用的随机对照研究  

Randomized controlled study on selective hepatic vascular versus complete clamping in hepatectomy

作　　者：李广罡[1] 唐庆贺[1] 傅思源[1] 周伟平[1] 

机构地区：[1]上海第二军医大学东方肝胆外科医院肝外三科,上海200438

出　　处：《国际外科学杂志》2009年第4期235-238,共4页International Journal of Surgery

摘　　要：目的比较3种人肝血流阻断方法，即Pringle法（A组）、半肝阻断法（B组）、单纯门静脉阻断法（C组）在肝切除术中的应用效果。方法采用随机对照研究的方法，将行肝切除术的患者随机分为3组，采用不同的阻断方法，对3组手术前后肝功能变化及术中出血及术后并发症进行比较。结果B组中1例因分离单侧肝门困难而改用Pringle法；179例患者无围手术期死亡；术中出血量3组间比较差异无统计学意义；术后第1、3、7天B组和C组的肝功能改变（总胆红素、丙氨酸氨基转移酶及蛋白水平等）组间比较无统计学意义，两组与A组比较有统计学意义。结论3种人肝血流阻断方法在切肝过程中，控制术中出血效果满意，切肝过程中采用选择性人肝血流阻断较Pringle法对术后肝功能损伤较小。Objective To valuate different effects in hepatectomy of three inflow occlusion methods including pringle maneuver, hemihepatic occlusion and portal venous occlusion. Methods 180 patients undergoing hepatectomy were randomly assigned to pfingle group （group A ）, hemehepatie occlusion group （ group B） or PV occlusion group （ group C）. The amount of blood lost ts of liver enzymes alanine aminotransferase （ ALT ）, aspirate aminotransferase （ AST ）, total bilirubin （ TB ）, Serum albumin （ALB） and postoperative complication were also recorded. Results There was no operative mortality. One patient in group B changed into pringle maneuver due to the difficulties in dissecting the hemi-hepatic portal and was excluded. The amount of hemorrhage of three groups had no statistical difference. The ALT, AST, ALB and TB level of 1,3,7 days after operation had significant differences in three groups. The pringle group had a higher level ALT, AST, TB and lower ALB level than the other two groups. Conclusions All techniques of occlusion are effective and feasible for patients undergoing hepatectomies. However, compared with pringle maneuver, PV clamping and hemihepatic occlusion can relieve the liver function damage after hepatectomy.

关 键 词：肝切除术 人肝血流阻断 随机病例对照研究 

分 类 号：R735.7[医药卫生—肿瘤] R969.4[医药卫生—临床医学]