半肝血流完全阻断法在肝功能受损的肝细胞癌患者肝切除术中的应用  

Application of total hemihepatic vascular exclusion in liver resection for patients with hepatocellularcarcinoma and impaired liver function

作　　者：隋承军[1] 陆炯炯[1] 徐峰[1] 沈伟峰[1] 耿利[1] 谢峰[1] 戴炳华[1] 杨甲梅[1] 

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

出　　处：《中华外科杂志》2013年第4期331-334,共4页Chinese Journal of Surgery

摘　　要：目的探讨半肝血流完全阻断法（THHVE）在肝功能受损的肝细胞癌（简称肝癌）患者肝切除术中的应用价值。方法回顾分析2009年1月至2011年10月行肝切除术的术前有肝功能损害的70例肝癌患者的临床资料。其中行THHVE38例（THHVE组），行Pringle法25例（Pringle法组），未行任何阻断7例。THHVE组男性36例，女性2例，平均年龄（54±9）岁；Pringle法组男性23例，女性2例，平均年龄（53±10）岁。比较两组术中总出血量、输血例数、阻断时间、并发症发生率、术后住院时间及术后肝功能恢复情况。结果THHVE组与Pringle法组比较术中总出血量[（317±-186）ml比（5064±274）ml，t=-3．025，P=0．004]及需要输血的患者比例（10．5％比32．0％，X^2=4．509，P=0．034）均明显低。THHVE组的血流阻断时间要长于Pringle法组[（21±5）min比（17±5）min，t=3．209，P=0．002]，但THHVE组术后第3、7天的总胆红素及术后第1、3、7天的ATJT均明显低于Pringle法组，术后第7天的前清蛋白明显高于Pringle法组。THHVE组与Pringle法组比较总并发症发生率（26．3％比52．0％，X^2=4．291，P=0．038）及严重并发症发生率（7．9％比28．0％，X^2=4．565，P=0．033）均明显低，术后住院时间也更短[（14．04±2．6）d比（16．44±4．0）d，t=-2．625，P=0．012]。结论THHVE应用于肝功能受损肝癌患者的肝切除术是安全、有效的，可以明显减少术中出血量、降低输血率、改善术后肝功能恢复、降低并发症的发生率及缩短术后住院时间。Objective To study the clinical value of total hemihepatic vascular exclusion（THHVE） in liver resection for patients with hepatoeellular carcinoma （ HCC ） and impaired liver function. Methods The data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively. THHVE was applied in 38 patients （THHVE group） , Pringle maneuver in 25 patients （Pringle group） and no vascular occlusion in 7 patients. In the THHVE group, 36 patients were male, 2 were female, average age was （ 54± 9 ） years. And in Pringle group, 23 patients were male, 2 were female, average age was （53± 10） years. Total intraoperative blood loss, blood transfusion rate, clamping time, postoperative complication rate, postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group. Results Total blood loss（（317±186） ml vs. （506±274） ml, t= -3.025, P=0.004） and transfusion rate （10.5% vs. 32. 0%, X2 = 4. 509, P = 0. 034 ） were significantly lower in the THHVE group than in the Pringle group. Although the clamping time was longer （ （21 ±5 ） minutes vs. （ 17± 5 ） minutes, t = 3. 209, P = 0. 002 ） , the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1, 3, 7 were significantly lower in the THHVE group than in the Pringle group, and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group. Total complication rate （26. 3% vs. 52.0%, X2 =4.291, P=0.038） and major complication rate （7.9% vs. 28.0%, X2 =4.565, P= 0. 033） were lower in the THHVE group than in the Pringle group. And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group （ （ 14. 0 ± 2. 6） d vs. （ 16.4 ±4. 0） d, t =-2. 625, P = 0. 012 ）. Conclusions THHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function. It is a

关 键 词：癌 肝细胞 肝切除术 外科手术 选择性 

分 类 号：R735.7[医药卫生—肿瘤]