不同肝血流阻断方法对半肝切除手术预后的影响  

The effect of different hepatic vascular exclusion on prognosis of patients undergoing hemihepatectomy

作　　者：张成武[1] 赵大建[1] 刘杰[1] 金望迅[1] 吴伟顶[1] 

机构地区：[1]浙江省人民医院肝胆外科,杭州310014

出　　处：《中华普通外科杂志》2012年第6期463-466,共4页Chinese Journal of General Surgery

摘　　要：目的探讨3种不同肝血流阻断方法对半肝切除术手术预后的影响。方法总结分析216例半肝切除术患者的临床资料，按术中所采用的肝血流阻断方法将患者分为3组：Pringle法为A组98例，选择性出入肝血流阻断术为B组71例，肝悬吊法联合选择性出入肝血流阻断术为C组47例。结果3组间平均手术时间差异无统计学意义（分别t=0．72，0．83，0．67，均P〉0．05）；A组平均术中出血量为和平均输血量均明显多于B、C组（分别t=3．72，3．83，4．11，4．07，均P〈0．05），B、C两组间差异无统计学意义（t=1．08，P〉0．05）；A组患者术后第1、3天血清白蛋白水平显著低于B、C组（分别t=3．65，3．77，3．90，3．74，均P〈0．05）；A组患者术后第3、5天血清总胆红素水平明显高于B、C组（分别t=4．13，5．01，4．09，3．99，均P〈0．05）；A组术后第1、3、5天血清丙氨酸转氨酶水平显著高于B、C组（分别t=5．36、6．14，5．70，7．01，4．94，3．98，均P〈0．05）；A组患者术后并发症发生率明显高于B、c组（分别χ2=13．71，23．56，均P〈0．05）。B、C组患者术后肝功能变化及并发症发生率差异无统计学意义（均P〉0．05）。3组恶性肿瘤患者的术后3年生存率差异无统计学意义（t=2．38，P〉0．05）。结论半肝切除术中采用选择性出入肝血流阻断术或与肝悬吊法联合应用，均可显著减少术中出血，减轻术后肝功能损害及降低术后并发症的发生率。选择性出入肝血流阻断术可作为半肝切除术中血流阻断的首选方法。Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy. Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively. Ninety-eight out of 216 patients received Pringie maneuver during hepatectomy in group A, 71 patients of selective liver inflow and outflow vascular exclusions in group B, 47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C. Results There was no difference in operation time between the three groups （ t = 0. 72, 0. 83, and 0. 67, P 〉 0. 05 ）. The intraoperative blood loss and transfusion in group B and C were less than that in group A （ t = 3.72, 3.83 and 4. 11,4. 07, P 〈 0. 05 ）. Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A （ t = 3. 65, 3. 77, and 3.90, 3.74, P 〈 0. 05 ）. Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A （ t = 4. 13, 5.01, and 4. 09, 3.99, P〈0.05）. Serum alanine aminotransferase on day 1, 3 and 5 in group B and C were lower than that in group A （t = 5.36, 6. 14, and 5.70, 7. 01, and 4. 94, 3.98, P 〈 0. 05）. Postoperative complication rate in group A was higher than that in group B and C （χ2 = 13.71 and 23.56, P 〈 0. 05 ）. The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different （ t = 2. 38, P 〉 0. 05 ）. Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced, and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging

关 键 词：肝切除术 止血 手术 

分 类 号：R735.7[医药卫生—肿瘤]