术中肝门阻断对肝细胞肝癌合并门静脉分支癌栓患者肝功能的影响  

Effect of Hepatic Vascular Inflow Occlusion during Hepatectomy on Liver Functions in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis

作　　者：兰军良[1] 贾户亮[2] 

机构地区：[1]山西省临汾市人民医院普外科,山西临汾041000 [2]复旦大学附属中山医院肝外科,上海200032

出　　处：《中国临床医学》2013年第5期650-652,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨肝细胞肝癌(HCC)合并门静脉分支癌栓(portal vein tumor thrombosis,PVTT)患者术中肝门阻断对术后肝功能恢复的影响。方法:选择2012年6月—2013年4月收治的HCC患者39例,其中合并及不合并PVTT的患者分别为18例和21例,在肝门阻断下行肝段以上的肝脏切除术,比较其术后肝功能恢复情况。结果:两组患者肝硬化分级、肝门阻断时间及手术时间差异有统计学意义。两组患者术后1、3、5天的总胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、凝血酶原时间比较,差异无统计学意义;HCC合并PVTT组患者术后第1、3天的前白蛋白及第1天的白蛋白分别为(0.14±0.04)、(0.09±0.14)和(37.17±3.19)g/L,与HCC不合并PVTT组患者[(0.19±0.05)、(0.11±0.04)、(39.48±3.16)g/L]比较,差异有统计学意义(P值分别为0.002、0.02及0.03)。结论:HCC合并PVTT患者术中行肝门阻断安全有效,术后患者肝脏合成前白蛋白的能力较不合并PVTT患者短期下降更明显,在术后第5天均未恢复正常,需加强保肝治疗。Objective：To explore the effect of hepatic vascular inflow occlusion during hepatectomy on liver functions in hepatocellular carcinoma （HCC） patients with portal vein tumor thrombosis （PVTT）.Methods：The clinical data of 39 HCC patients with PVTT （n =18） or without PVTT （n =21） selected from June 2012 to April 2013 were reviewed.Hepatic vascular inflow occlusion by the Pringle maneuver was used during hepatectomy,and post-operation recovery of liver functions was analyzed.Results：There were significant differences between the two groups in grades of cirrhosis,time of hepatic vascular occlusion and duration of operation.There were no significant differences between the two groups in total bilirubin （TBIL） 、alanine aminotransferase （ALT）、aspartate amino transferase （AST） and prothrombin time （PT） on the 1st,3rd,5th day after operation.Blood serum pre-albumin （pre-ALB） on the 1st,3rd day after operation and ALB on the 1st day after operation in HCC with PVTT group were （0.14± 0.04）g/L、（0.09 ± 0.14）g/L and（37.17 ± 3.19）g/L,which were lower than those in HCC without PVTT group [（0.19 ± 0.05）,（0.11 ± 0.04） and （39.48 ± 3.16） g/L],P values were 0.002,0.02 and 0.03,respectively.Conclusions：Hepatic vascular inflow occlusion during hepatectomy in HCC with PVTT is safe and effective.Blood serum pre-albumin of HCC can not reach normal level on the 5th day after operation,and it is more lower in HCC patients with PVTT than in HCC patients without PVTT.More attention shoud be paid about liver functions recovery in HCC patients with PVTT.

关 键 词：肝细胞肝癌 门静脉癌栓 肝功能 肝门阻断 

分 类 号：R735.7[医药卫生—肿瘤]