持续肝动脉阻断预防破裂性肝癌肝切除术中大出血  

Continuous occlusion of hepatic artery for prevention of blood loss in partial hepatectomy for rupturedhepatocellular carcinoma

作　　者：夏锋[1] 马宽生[1] 李晓武[1] 王曙光[1] 别平[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院 ,重庆400038

出　　处：《中华消化外科杂志》2011年第4期260-262,共3页Chinese Journal of Digestive Surgery

摘　　要：目的探讨应用持续肝动脉阻断技术对预防破裂性肝癌肝切除术中大出血的价值。方法回顾性分析2006年5月至2010年4月第三军医大学西南医院收治的36例应用Pringle法＋持续肝动脉阻断技术对破裂性肝癌患者（研究组）行肝切除术的临床资料。在肝癌数据库中配对选取同期36例采用纱布压迫止血的肝癌破裂出血手术患者（对照组）。对两组患者术中和术后的相关指标采用方差分析、X^2检验、Fisher确切概率法进行对比分析。结果研究组患者动脉持续阻断中位时间为58min（36—98min）；术中中位出血量为400ml，明显少于对照组的750ml（F=16．47，P〈0．05）；研究组78％（28／36）的患者未进行输血治疗，明显优于对照组的53％（19／36），两组比较，差异有统计学意义（X^2=6．01，P〈0．05）。两组患者围手术期AST、TBil均在术后第2天达到最高值，然后逐渐下降，1周左右降至正常范围。两组患者的术后并发症发生率和并发症分级比较，差异无统计学意义（X^2=1．83，0．89，P〉0．05）。结论 应用持续肝动脉阻断技术可明显减少破裂性肝癌肝切除术的术中出血量，且不会对肝功能产生明显的不良影响。Objective To investigate the value of continuous occlusion of hepatic artery proper to inter- mittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma （HCC）. Methods The clinical data of 36 patients （test group） who received partial hepateetomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at the Southwest Hospital were retrospectively analyzed. Thirty-six patients （control group） who received intermittent Pringle maneuver only were selected as the control. All data were analyzed using the chi-square test, Fisher exact probability and analysis of variance. Results The mean hepatic artery occlusion time of the test group was 58 minutes （range, 36-98 minutes）. The median blood loss of the test group was 400 ml, which was significantly less than 750 ml of the control group （ F = 16. 47, P 〈 0.05 ） ; 78% （28/36） of patients in the test group did not receive blood transfusion, which was signif- icantly more than 53% （19/36） of the control group （ X^2 = 6.01, P 〈 0.05 ）. The levels of postoperative serum aspartate transaminase and total bilirubin of the 2 groups were peaked at postoperative day 2 and then decreased to the normal level 1 week later. There were no significant differences in the incidences and levels of complications between the 2 groups （ X^2 = 1.83, 0.89, P 〉 0.05）. Conclusion The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduces intraoperative blood loss and doesn＇t bring any adverse effects to hepatic function for partial hepatectomy in patients with ruptured HCC when compared with inter- mittent Pringle maneuver alone.

关 键 词：肝肿瘤 肝切除术 肝动脉持续阻断 肿瘤破裂 

分 类 号：R735.7[医药卫生—肿瘤]