半肝血流完全阻断法在肝细胞癌右肝切除术中的应用  

Right hepatectomy with total hemihepatic vascular exclusion in hepatocellular carcinoma

作　　者：隋承军[1] 徐峰[1] 沈伟峰[1] 阚彤[1] 谢峰[1] 耿利[1] 黄杨卿[1] 杨甲梅[1] 

机构地区：[1]第二军医大学东方肝胆医院特需治疗一科、肝移植科,上海200438

出　　处：《中华肝胆外科杂志》2012年第10期769-772,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨半肝血流完全阻断法（total hemihepatic vascular exclusion，THHVE）在肝细胞癌右肝叶切除术中的应用价值。方法回顾分析东方肝胆外科医院特需治疗一科、肝移植科2006年2月至2008年12月同一手术组收治的123例行右肝切除的肝细胞癌患者的临床资料。结果58例采用THHVE法阻断（A组），65例采用全肝入肝血流阻断法（Pringle法）阻断（B组）。两组比较在肿瘤最大径（7．69±3．70cm比6．08±4．07cm）和血流阻断时间（28．55±8．67min比19．85±6．74min）上A组明显大于B组，P〈0．05。而在术中总出血量（304．31±270．36ml比542．62±876．84ml）以及在术后第1、3、7天谷丙转氨酶升高的程度及并发症的发生率（18．97％比38．46％）上A组明显低于B组（P〈0．05）。结论THHVE法行右肝切除治疗肝细胞癌可减少术中的出血，减轻肝功能损害，降低术后并发症的发生率和病死率。Objective To explore the clinical value of total hemihepatic vascular exclusion （THHVE） in right hepatectomy for hepatocellular carcinoma （HCC）. Methods One hundred and twenty-three consecutive patients who underwent right hepatectomy for HCC between February 2006 and December 2008 were studied retrospectively. THHVE was used in 58 patients （group A） and Pringle maneuver in 65 patients （group t3）. The patient＇s demographics, surgical procedure and out come were collected and compared between the two groups. Results The tumor size was significantly bigger in group A than group B （7.69±3.70 cm vs. 6.08±4.07 cm, P〈0.05）. The vascular occlu- sion time in group A was significantly longer than group B （28.55±8.67 min vs. 19.85± 6.71 rain, P〈 0. 05）. However, intraoperative blood loss in group A was significantly less than group B （304.31±270.36 ml vs. 542.62±876.84 ml, P〈0.05）, and the elevation of serum alanine amin- otransferase （ALT） on day-1 ,-3 and-7 after operation in group A were significantly lower than group B （P〈0.05）. The postoperative complication rate in group A was lower than group B （18.97% vs. 38.46%, P〈0.05）. Conclusion THHVE was a safe and efficacious technique in right hepatectomy for HCC. It significantly decreased blood loss, alleviated liver injury and reduced postoperative mor- bidity and mortality.

关 键 词：肝血流阻断 肝切除术 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]