不阻断肝门的精准限量肝切除技术在肝硬化条件下的应用  

Application of precise hepatectomy without hepatic portal occlusion under condition of cirrhosis

作　　者：刘水根 陈湘平 王云 张裕华 叶春华 李忠 谭黎明 李复员 

机构地区：[1]湖南省湘乡市人民医院肝胆外科,湖南湘乡411400 [2]湖南省湘潭市中心医院肝胆外科,湖南湘潭411100 [3]湖南省湘潭县人民医院普通外科,湖南湘潭411200 [4]湖南省湘乡市人民医院超声科,湖南湘乡411400

出　　处：《中国现代医学杂志》2011年第26期3302-3305,3308,共5页China Journal of Modern Medicine

基　　金：湖南省湘潭市社会发展科技计划项目(No:S2010S0013)

摘　　要：目的评价在肝硬化条件下不阻断肝门的精准限量肝切除技术的安全性和临床价值。方法 176例有肝切除手术指征的肝硬化患者随机分为两组。A组101例,采用不阻断入肝血流的精准限量肝切除技术,B组75例,采用阻断入肝血流的传统肝切除技术,比较两组的手术时间、住院时间、术中出血量、输血率、并发症发生率、死亡率及手术前后肝功能指标(ALB、ALT、TB)的变化,标本切缘阳性率及近期预后。结果全部病例无术后出血、胆漏等并发症发生,两组平均手术时间、住院时间及肝细胞肝癌1年生存率比较,差异无统计学意义(P>0.05),A组术中出血量、输血率、并发症发生率、死亡率均低于B组(P<0.05),而1年无瘤生存率高于B组(P<0.01),肝功能损害较B组轻(P<0.05),差异有统计学意义。结论在肝硬化条件下,不阻断入肝血流的精准限量肝切除技术优于传统肝切除技术,是对精准肝切除技术的改良。【Objective】 To evaluate the safety and clinical value of precise hepatectomy without hepatic portal occlusion under the condition of cirrhosis.【Methods】 176 patients with cirrhosis who had the indication of hepatectomy were randomly divided into two groups： 101 patients in group A received precise hepatectomy without hepatic portal occlusion and 75 patients in group B received traditional hepatectomy with hepatic portal occlusion.It was compared between the two groups in the mean operative time,length of stay,intraoperative blood loss,blood transfusion rate,complication incidence rate,mortality,pre-and postoperative hepatic function indexes including albumin（ALB）,alanine aminotransferase（ALT） and total bilirubin（TB）,the positive rates of specimen incisal margin and short-term prognosis.【Results】 No complication such as postoperative bleeding and bile leakage existed in all the patients.There was no statistically significant difference between the two groups in the mean operative time,length of stay,one-year survival rate in those patients with hepatocellular carcinoma（P〈0.05）.The intraoperative blood loss,blood transfusion rate,complication incidence rate and mortality in group A were lower than those in group B（P〈0.05）.While the one-year disease free survival（DFS） in group A was higher than that in group B（P〈0.01） and hepatic functional lesion was slighter than that in group B（P〈0.05）.【Conclusion】 As a modified operative technique,precise hepatectomy without hepatic portal occlusion gain an advantage over traditional hepatectomy under the condition of cirrhosis.

关 键 词：肝硬化 精准 限量肝切除 阻断/不阻断肝门 安全性 

分 类 号：R657.3[医药卫生—外科学] R575.2[医药卫生—临床医学]