肝断面血流阻断器在肝癌切除术中的应用  

Application of hepatic blood blocker to control bleeding during hepatectomy

作　　者：周松[1] 薛小军[1] 李冉冉[1] 陈达丰[1] 陈文有[1] 刘广欣[1] 柯恩明[1] 郑硕云[1] 

机构地区：[1]中国人民解放军第175医院(厦门大学附属东南医院)普通外科,福建省漳州市363000

出　　处：《世界华人消化杂志》2012年第9期790-794,共5页World Chinese Journal of Digestology

摘　　要：目的:比较不同的肝血流阻断方法在肝切除术中应用的有效性及安全性.方法:回顾性分析我院2004-2009年117例行肝切除术的肝癌患者的相关资料.A组:自制肝断面血流阻断器局部血流控制(n=42);B组:解剖性半肝血流阻断(n=35);C组:第一肝门阻断(Pringle法,n=40).比较3组患者术中出血量和手术时间、术后肝功能的恢复以及术后并发症的发生率.结果:术中出血量和手术时间A组均明显少于B(P=0.026,P<0.001)、C(P<0.001,P<0.001)组.A组术后第3、7天肝功能(TB、ALT)的明显好于C组(TB:P=0.014,=0.009;ALT:P<0.001,P<0.001).C组术后有29例出现不同程度的腹水,术后腹水发生率显著高于A组(P<0.001);2例发生肝功能衰竭,1例出现胃肠道出血,死亡1例.结论:肝切除术中采用肝断面血流阻断器能有效控制出血、缩短手术时间,对肝功能影响小,是一种简便、安全有效的方法.AIM：To compare a new tool named hepatic blood blocker versus the Pringle maneuver and hemihepatic vascular exclusion in controlling bleeding during hepatectomy for liver cancer.METHODS：The clinical data for 117 patients who underwent hepatectomy for liver cancer from 2004 to 2009 were analyzed retrospectively.Of these patients,42 underwent local hepatic blood occlusion with hepatic blood blocker（group A）,35 underwent hemihepatic vascular exclusion（group B）,and 40 underwent the Pringle maneuver（group C）.The blood loss,operative time,postoperative hepatic function and complications were compared among each group.RESULTS：The average blood loss and operative time were significantly less in group A than in groups B（P 0.05,0.001） and C（both P 0.001）.Signif icant differences were seen between group A and group C in serum total bilirubin（TB） and alanine transaminase（ALT） on postoperative days 3 and day 7,and group A showed better hepatic function（TB：P = 0.014,0.009;ALT：both P 0.001）.The Pringle maneuver significantly increased the rate of postoperative abdominal dropsy when compared to group A（P 0.001）.In group C,two patients suffered from liver failure,one suffered from alimentary tract hemorrhage and one died.CONCLUSION：Using hepatic blood blocker during hepatectomy could effectively control bleeding,reduce operative time and preserve hepatic function,representing a safe and feasible technique.

关 键 词：肝癌 肝切除术 局部血流控制 半肝血流阻断 第一肝门阻断 

分 类 号：R735.7[医药卫生—肿瘤]