半肝血流阻断技术用于肝硬化肝癌的肝切除  

Hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma

作　　者：靳斌[1] 姜旭生[1] 张宗利[1] 朱民[1] 刘崇忠[1] 陈波[1] 胡三元[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012

出　　处：《中华普通外科杂志》2010年第6期439-441,共3页Chinese Journal of General Surgery

基　　金：山东省自然科学基金资助项目（Y2008C10）

摘　　要：目的 探讨半肝血流阻断技术在合并肝硬化的肝癌手术治疗中的意义.方法 回顾性分析山东大学齐鲁医院普外科2006年3月至2008年9月因肝癌行肝切除205例患者的临床资料,其中术中应用Pringle法第一肝门阻断入肝血流44例（A组）、半肝血流阻断76例（B组）、半肝血流阻断加选择性肝静脉控制85例（C组）.比较3组患者肝切除手术时间和术中出血量,术后肝功能的恢复以及术后并发症.结果 3组患者肝切除手术时间比较差异无统计学意义（F=2.53,P〉0.05） 术中平均出血量分别为543.7、415.8、324.5 ml,3组间比较差异有统计学意义（F=98.96,P〈0.001） 在术后3 d和6 d的血清丙氨酸转氨酶、胆红素水平比较,B组和C组明显优于A组.结论 半肝血流阻断可防止健侧肝脏缺血再灌注损伤 肝外控制肝静脉,可显著减少肝切除术中的出血量.Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma（HCC） using Pringle maneuver （groupA,n=44）,hemihepatic vascular occlusion（group B,n=76） and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins（group C,n=85）were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups（543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P〈0.001）.There was no difference in the time of operation.The level of serum alanine transaminase（ALT） and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.

关 键 词：癌 肝细胞 肝切除术 半肝血流阻断 肝静脉 

分 类 号：R735.7[医药卫生—肿瘤]