选择性半肝血流阻断在肝海绵状血管瘤切除中的应用  

Selective hemihepatic vascular occlusion for hepatic resection of cavernous hemangioma

作　　者：张涛[1] 刘晶[1] 王克华[1] 牛占学[1] 刘东涛[1] 李明皓 

机构地区：[1]宁夏医科大学肝胆外科,宁夏银川750004 [2]宁夏人民医院肝胆外科,宁夏银川750004

出　　处：《中国普通外科杂志》2012年第7期854-858,共5页China Journal of General Surgery

基　　金：宁夏回族自治区科技攻关计划资助项目(2006123)

摘　　要：目的:探讨选择性半肝血流阻断在肝海绵状血管瘤切除中的应用效果。方法:回顾性分析2006年1月—2011年1月经手术切除的104例肝海绵状血管瘤患者的临床资料。其中26例行选择性半肝血流阻断(A组),78例行第一肝门阻断(Pringle法)(B组)。比较并分析两种方法对术中情况、术后肝功能恢复、并发症发生率等指标的影响。结果:104例手术均顺利完成。两组间术中失血量、输血量、阻断时间、血氧饱和度以及术后肠道恢复时间、并发症等指标的差异均无统计学意义(均P>0.05),但B组术中外周动脉血压及术中脉搏变化明显大于A组(均P<0.01)。术后肝功能指标如ALT,AST,ALB,TBIL等改变,B组优于A组,差异均有统计学意义(P<0.05或P<0.01)。结论:肝海绵状血管瘤切除术中采用选择性半肝血流阻断,能有效地减轻肝血流阻断对全身血流动力学的影响,减轻缺血再灌注损伤,有利于术后肝功能恢复。Objective： To investigate the efficacy of selective hemihepatic vascular occlusion in hepatectomy for cavernous hemangioma. Methods： The clinical data of 104 patients with hepatic cavernous hemangioma undergoing surgical resection from January 2006 to January 2011 were retrospectively analyzed.Of the patients,selective hemihepatic vascular occlusion was performed in 26 cases（group A）,and the Pringle maneuver was performed in 78 patients（group B）.The influence of the two approaches on the parameters that included intraoperative conditions,postoperative liver function and incidence of complications were compared and analyzed. Results： Operations were successfully performed in all the 104 patients.There were no statistical differences in intraoperative bleeding,blood transfusion volume,hepatic inflow occlusion time,blood oxygen saturation,time to intestinal function recovery and incidence of complication between the two groups（all P0.05）,but the alterations of peripheral blood pressure and arterial pulse in group B were more evident than those in group A（both P0.01）.The postoperative changes of liver function parameters such as ALT,AST,ALB and TBIL in group B were more favorable than those in group A,and all the differences had statistical significance（P0.05 or P0.01）. Conclusion： Using selective hemihepatic vascular occlusion in hepatic resection of cavernous hemangiom can effectively reduce the impact of hepatic blood flow occlusion on systemic hemodynamics,alleviate hepatic ischemia–reperfusion injury,and thereby facilitate recovery of postoperative liver function.

关 键 词：肝切除术/方法 血管瘤 海绵状 肝 半肝血流阻断 PRINGLE法 

分 类 号：R657.3[医药卫生—外科学]