辛氏钳钳夹阻断肝静脉技术在复杂肝脏肿瘤切除术中的应用  

Hepatic vein occlusion with Satinsky clamp in hepatectomy for complicated liver tumor

作　　者：汪珍光[1] 傅思源[1] 潘泽亚[1] 黄罡[1] 杨远[1] 章琎[1] 刘辉[1] 林川[1] 李爱军[1] 周伟平[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外三科,上海200438

出　　处：《中华外科杂志》2012年第6期491-493,共3页Chinese Journal of Surgery

基　　金：“十一五”国家科技重大专项资助项目（2008ZX10002）

摘　　要：目的探讨改良的肝静脉阻断技术在复杂肝脏肿瘤切除手术中的应用。方法2003年1月至2010年12月，采用Pringle法加辛氏钳钳夹阻断肝静脉技术切除第二肝门区复杂肝脏肿瘤330例。其中男性245例，女性85例；平均年龄（50±11）岁。肿瘤平均直径（9±6）cm。271例患者合并乙肝，215例合并肝硬化；术前肝功能ChildA级321例，B级9例。术中血流阻断方式采用Pringle法联合辛氏钳钳夹阻断肝静脉技术，使用钳夹法切肝。结果330例患者术中均成功采用了辛氏钳钳夹阻断肝静脉技术。平均手术时间（132±29）min，平均肝静脉分离时间（7±3）min，平均术中肝血流阻断时间（22±7）min。平均术中出血量（480±265）ml，66例患者输血，平均输血量1．2单位浓缩红细胞。术中未出现肝静脉大出血、空气栓塞和肝静脉分离失败。手术相关并发症61例（18．5％），包括31例胸腔积液、14例腹腔积液、10例胆漏、2例术中大出血、2例术后再出血、2例肝功能不全。围手术期无死亡病例。结论辛氏钳钳夹阻断肝静脉技术操作简便，成功率高，适合临床推广应用。Objective To investigate the application of an improved method of hepatic vein occlusion with Satinsky clamp when resecting the liver tumor involving second hepatic portal. Methods From January 2003 to December 2010, there were totally 330 patients with liver tumor admitted, who underwent liver resection with Pringle maneuver plus hepatic vein occlusion with Satinsky clamp. Data regarding the intra-operative and post-operative course of the patients were analyzed. There were 245 male and 85 female patients, with a mean age of （ 50 ± 11 ） years. The diameter of tumor was （ 9±6 ） era. Among the 330 patients, there were 271 patients with viral hepatitis B, 215 patients with liver cirrhosis; 321 patients were in Child class A of liver function and 9 in class B. Pringle maneuver plus hepatic vein occlusion with Satinsky clamp was used to occlude the blood flow in the liver resection. The liver transection was performed with clamp-crushing technique. Results Hepatic vein occlusion with Satinsky clamp was successful in all 330 patients. The operation time was （ 132±29 ） minutes, while （7 ± 3 ） minutes for dissecting hepatic vein and （ 22± 7 ） minutes for inflow blood occlusion. The blood loss in operation was （480 ± 265 ） ml, with 20% of patients receiving blood transfusion. No patient had large hemorrhage and air embolism due to hepatic vein laceration. No patient died in the perioperative period. The complications included 31 patients of pleural effusion, 14 patients of seroperitoneum, 10 patients of biliaryfistula, 2 patients of massive blood loss during liver resection and 2 patients of re-bleeding after operation. Conclusion The method of hepatic vein occlusion with Santisky clamp was safe and effective.

关 键 词：肝肿瘤 肝切除术 肝静脉 外科器械 

分 类 号：R735.7[医药卫生—肿瘤]