选择性出入肝血流阻断在巨大肝癌肝切除术中的应用  

Effects of selective hepatic vascular occlusion on the prognosis of patients undergoing hepatic resection for huge liver cancer

作　　者：吴伟顶[1] 胡智明[1] 赵大建[1] 张成武[1] 张宇华[1] 刘杰[1] 叶再元[1] 

机构地区：[1]浙江省人民医院肝胆外科,杭州310014

出　　处：《中华消化外科杂志》2012年第6期514-517,共4页Chinese Journal of Digestive Surgery

基　　金：浙江省卫生厅资助项目（2010KYA018）

摘　　要：目的探讨行巨大肝癌肝切除术时选择性出入肝血流阻断技术对患者预后的影响。方法回顾性分析2005年1月至2010年1月浙江省人民医院收治的49例巨大肝癌行肝切除术患者的临床资料。根据肝脏血流阻断技术不同，分为第一肝门血流阻断组（第一肝门组，24例）和选择性出入肝血流阻断组（选择阻断组，25例）。分析两组患者手术情况、肝肾功能、并发症、生存率和肝癌复发情况。计量资料采用t检验，计数资料比较采用X。检验或Fisher确切概率法，采用Kaplan—Meier法绘制生存曲线，生存情况比较采用Log—rank检验。结果两组患者均顺利施行肝切除术，第一肝门组患者的肝血流阻断时间为（32±19）rain，选择阻断组为（34±22）min，两组比较，差异无统计学意义（t=2．45，P〉0．05）。第一肝门组患者的术中出血量为（736±543）ml，明显多于选择阻断组（273±298）ml（t=6．87，P〈0．05）。第一肝门组患者肝静脉损伤的发生率为21％〈5／24），选择阻断组为24％（6／25），两组比较，差异无统计学意义（x^2=1．45，P〉0．05）。第一肝门组有3例患者出现肝静脉破裂大出血，1例患者发生空气栓塞抢救无效死亡；选择阻断组未发生上述情况。第一肝门组患者中4例发现肿瘤侵犯血管，选择阻断组患者中3例发现肿瘤侵犯血管，两组患者切缘均为阴性。两组术前肝功能无明显差别，选择阻断组术后第1、3天ALT值较第一肝门组明显降低（t=7．12，6．35，P〈0．05）；两组尿素氮、肌酐比较，差异无统计学意义（P〉0．05）。第一肝门组术后发生急性肝功能衰竭4例，选择阻断组无一例发生术后急性肝功能衰竭。第一肝门组1、3年无瘤生存率分别为58％、21％，明显低于选择阻断组的72％、30％（x^2=5．32，6．07，P〈0．05）。第一肝门组5年无瘤生存率为21％，选择阻断组为Objective To evaluate the effects of selective hepatic vascular occlusion （SHVO） on the prognosis of patients undergoing hepatic resection for huge liver cancer. Methods The clinical data of 49 patients who received huge liver cancer resection at the Zhejiang People＇s Hospital from January 2005 to January 2010 were retrospectively analyzed. Based on the type of hepatic vascular occlusion, all patients were divided into Pringle＇s maneuver group （24 patients） and SHVO group （25 patients）. The intraoperative condition, postoperative recovery of hepatic and renal function, incidence of complications, survival rate and recurrence rate of liver cancer of the 2 groups were compared. All data were analyzed by using the t test or Fisher exact probability. The survival curve was drawn by using the Kaplan-Meier method and the survival of the 2 groups was compared by using the Log-rank test. Results Hepateetomy was successfully performed on all the patients. Time for blood occlusion were （32 ± 19） minutes in the Pringle＇s maneuver group and （34± 22）minutes in the SHVO group, with no significant difference between the 2 groups （ t = 2.45, P 〉 0.05 ）. The volume of blood loss of the Pringle＇s maneuver group was （736 ± 543 ） ml, which was significantly greater than （ 273 ± 298） ml of the SHVO group （ t = 6. 87, P 〈 0.05 ）. The incidences of hepatic vein rupture were 21% （5/24） in the Pringle＇s maneuver group and 24% （6/25） in the SHVO group, with no significant difference （X2= 1.45, P 〉0.05）. The course of 3 patients was complicated by hepatic vein rupture and hemorrhage and 1 by air embolism in the Pringle＇s maneuver group, while no hemorrhage or air embolism happened in the SHVO group. Four patients in the Pringle＇s maneuver group and 3 in the SHVO group were found with vascular invasion, while the resection margins were negative. There was no significant difference in the hepatic function in the 2 groups before operation. The levels of alanine aminotrans

关 键 词：肝肿瘤 肝切除术 肝血流阻断 复发 

分 类 号：R735.7[医药卫生—肿瘤]