半肝入肝血流阻断法与第一肝门血流阻断法在肝癌切除术中应用的比较  

Comparison of hemihepatic blood inflow occlusion without hepaticportal dissection with Pringle′ s occlusion in hepatectomy of hepatocellular carcinoma

作　　者：黄兴华[1] 胡还章[1] 江艺[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福州350025

出　　处：《中华解剖与临床杂志》2015年第6期546-551,共6页Chinese Journal of Anatomy and Clinics

基　　金：基金项目：南京军区医学科技创新经费资助项目（112033）;福建省科技计划重点项目（2011Y0046）

摘　　要：目的：探讨不解剖肝门的半肝入肝血流阻断法和第一肝门血流阻断法（Pringle 法）在肝癌切除术中的应用效果,以及对术后复发率和生存率的影响。方法回顾性分析2010年2月—2012年8月南京军区福州总医院肝胆外科行手术切除的78例原发性肝癌患者的临床资料。按手术方式不同分为 A、B 两组,两组术中均不解剖第一肝门,其中 A 组40例,男27例、女13例,年龄26~70岁、平均52.95岁,术中应用半肝入肝血流阻断联合控制性低中心静脉压技术；B 组38例,男27例、女11例,年龄32~75岁、平均52.32岁,术中应用第一肝门血流阻断联合控制性低中心静脉压技术。观察比较2组患者术中出血量、入肝血流阻断时间、手术时间、输血例数,术后第1天 Child-Pugh 分级情况,术后1、3、7天血清 ALT 和总胆红素（TBiL）水平,术后并发症发生情况、住院时间。患者术后1个月以及此后每3个月定期门诊复查,观察2组患者血清 ALT 和 TBiL 的复常时间,患者复发率、生存率等指标。结果2组术前 Child-Pugh 分级、术前血清 ALT 和 TBiL 水平、手术时间、术中出血量、术中阻断时间、输血例数以及术后1、3、7天血清 TBiL 水平、术后并发症发生率,组间比较差异均无统计学意义（P 值均〉0.05）；A 组术后第1天 Child-Pugh 分级恶化率低于 B 组,差异有统计学意义（χ2=14.404, P 〈0.01）；A 组术后1、3、7天血清 ALT 水平和住院时间明显低于 B 组,差异均有统计学意义（t =3.363、3.065、3.403、5.663,P 值均〈0.01）； A 组术后血清 ALT 和 TBiL 恢复正常水平时间均明显短于 B 组,差异均有统计学意义（t =6.717、8.508,P 值均〈0.01）； A 组患者术后1、2年累积复发率低于 B 组,而术后1、2年累积生存率高于 B 组,但组间比较差异均无统计学意义（P 值均〉0.05）。 Log-rank 检验比较2组2年的累积生存率,差异无统计学意义（Log-rank 检验值=0.918Objective To compare the effects of the hemihepatic blood inflow occlusion with those of the first hepaticportal blood flow occlusion （ Pringle） in hepatectomy and investigate the influence of recurrence rates and survival rates of the two methods. Methods Data of 78 patients with hepatocellular carcinoma underwent hepatectomy in the Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Command from February 2010 to December 2012 were retrospectively analyzed. In group A （n =40） there were 27 males and 13 females with an average age of 52. 95 years （ range 26 - 70 years） underwent hepatectomy by hemihepatic blood inflow occlusion combined with controlled low central venous pressure without hepatic portal dissection. In group B （n = 38）, there were 27 males and 11 females with an average age of 52. 32 years （range 32 - 75 years） by the first hepaticportal blood flow occlusion combined with controlled low central venous pressure without hepatic portal dissection. The bleeding volumes,＆nbsp;occlusion duration, operation duration, numbers of cases with blood transfusion, the first day of Child-Pugh grades after operation, the levels of postoperative serum alanine aminotransferase（ALT） and total bilirubin （TBiL） at 1, 3, 7 d, postoperative complications, days of hospitalization were analyzed. Patients were reviewed after the first month and every three months of operation, duration of recovery of postoperative serum ALT and TBiL, recurrence rates and survival rates after operation, and other indexes were analyzed.Results Preoperative Child-Pugh grades, the levels of preoperative serum ALT and TBiL, operation duration, bleeding volume, occlusion durations, numbers of cases underwent blood transfusion, the levels of postoperative serum TBiL at 1, 3, 7 d, postoperative complications, between group A and B were not statistically different （ all P values 〉 0. 05） . The first day′ s deterioration of Child-Pugh grades after operation rate in group A was significant lowe

关 键 词：肝肿瘤 癌 肝细胞 肝切除术 中心静脉压 血流阻断 复发 

分 类 号：R735.7[医药卫生—肿瘤]