陈氏简易全肝血流阻断技术的临床应用:附280例报道  

Clinical application of Chen's simplified total hepatic vascular occlusion: a report of 280 cases

作　　者：周存才[1] 杨小敏[2] 周新文[1] 魏小勇[1] 徐国辉[1] 李小军[1] 徐宗全[1] 周峥[1] 曾志平[1] 饶荣生[1] 

机构地区：[1]江西省肿瘤医院肝肿瘤诊断治疗中心,江西南昌330029 [2]江西省肿瘤医院麻醉科,江西南昌330029

出　　处：《中国普通外科杂志》2014年第1期6-12,共7页China Journal of General Surgery

基　　金：江西省科技支撑计划资助项目(20122BBG70106-1)

摘　　要：目的：评价陈氏简易全肝血流阻断技术（第一肝门加肝下下腔静脉阻断）对肝创面出血程度的影响。方法：总结2010年1月-2013年1月280例肝脏外科手术患者的临床资料，将肝脏创面出血程度分成0～IV级，观察单纯施行第一肝门阻断及施行陈氏简易全肝血流阻断之后肝断面出血程度的变化。结果：280例患者施行第一肝门阻断之后有98例（35．0％，98/280）获得良好术野，其中肝创面出血程度0级45例，I级53例。另182例在加行肝下下腔静脉阻断之后有115例（41．1％，115/280）获得良好术野，其中肝创面出血程度0级55例，I级60例；47例（16．8％，47/280）肝创面出血程度有所减轻，其中II级39例，III级8例；13例（4．6％，13/280）肝创面出血程度无明显变化，其中II级10例，III级3例；3例（1．1％，3/280）IV级，肝静脉主干损伤导致大出血；4例（1．4％，4/280）因血压降至60mmHg（1mmHg=0．133kPa）以下放弃施行肝下下腔静脉阻断。结论：陈氏简易全肝血流阻断可安全有效地控制术中肝脏断面的出血，其操作简单，有利于实现清晰肝切除、精准肝切除。Objective： To evaluate the influence of Chen＇s simplified technique of total hepatic vascular occlusion （Pringle＇s maneuver plus infrahepatic vena cava occlusion） on the degree of bleeding from the cut surface of the liver. Methods： The clinical data of 280 patients undergoing liver resection from January 2010 to January 2013 werereviewed. The severity of bleeding from the cut surface of the liver was classified as grade 0 to grade IV, according to the clearness of operative field. Changes of the degree of bleeding of the liver section surface were recorded after performing the first hepatic portal occlusion （Pringle maneuver） and Chen＇s occlusion. Results： The operative field was excellent in 98 （98/280, 35%） cases of the 280 patients after Pringle＇s maneuver, which was classified as grade 0 in 45 cases and grade I in 53 cases. Of the remaining 182 patients undergoing additional infrahepatic vena cava occlusion, satisfactory operative field was achieved in 115 （115/280, 41.1%） cases, which was classified as grade 0 in 55 cases and grade I in 60 cases; the degree of bleeding from the cut surface was lessened in 47 （47/280, 16.8%） cases, which was classified as grade II in 39 cases and grade III in 8 cases, and showed no obvious improvement in 13 （13/280,4.6%） cases, which was classified as grade II in 10 cases and grade III in 3 cases; 3 （3/280, 1.1%） cases who developed massive hemorrhage due to the injury of the trunk of the hepatic veins were classified as grade IV; the procedure was abandoned in 4 （4/280, 1.4%） cases because the blood pressure dropped to below 60 mmHg （1 mmHg=0.133 kPa）. Conclusion： Chen＇s simplified total hepatic vascular ocdusion can safely and effectively control bleeding from the cut surface during liver transection, is easy to perform, and may facilitate a bloodless and precise liver resection.

关 键 词：肝切除术 方法 肝脏血流阻断技术 腔静脉 下 陈氏 

分 类 号：R657.3[医药卫生—外科学]