肝下下腔静脉阻断降低中心静脉压在肝切除手术中应用的系统评估  

Systematic evaluation for the role of decreasing central venous pressure by intrahepatic inferior vena cava clamping in liver resection

作　　者：郝杰[1] 王博[1] 刘学民[1] 吕毅[1] 韩洁[2] 于良[1] 

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061 [2]西安交通大学第一附属医院手术部,陕西西安710061

出　　处：《现代肿瘤医学》2016年第4期614-617,共4页Journal of Modern Oncology

基　　金：陕西省科技统筹创新工程计划项目(编号:2011KTCL03-21)

摘　　要：目的:系统性地评估肝下下腔静脉(infrahepatic inferior veno cava,IIVC)阻断在肝脏切除手术中的应用,包括控制出血和其安全性。方法:在Embase和Medline数据库检索IIVC阻断与肝切除手术的随机对照和观察研究,提取患者的一般信息、临床和手术资料等数据,系统性分析术中出血、中心静脉压(CVP)、并发症等结果,采用Review Manager软件进行森林图分析。结果:共有6篇文章纳入最后的系统分析,共计纳入702例病人,患者中绝大多数为恶性肿瘤。IIVC阻断可以有效控制术中CVP。相比限制液体入量等麻醉管理控制,IIVC阻断在降低术中总出血量、肝切除过程出血、输血方面效果更明显,并且不增加术后并发症的发生,对肾功能和肝功能没有不良影响。结论:IIVC作为控制肝切除术中出血的一种替代手段,相比麻醉管理具有更好的效果,可在临床安全实施。Objective： To systematically evaluate the role of infrahepatic inferior vena cava（ IIVC） clamping in liver resection including the control of blood loss and its safety. Methods： Relevant evidence regarding the infrahepatic inferior veno cava clamping and liver resection were searched till the end of March 2015. Data of general and clinical information was collected. A Meta-analysis was performed to examine the outcomes like blood loss,CVP and complications. Review manager was used to make forest plot. Results： Six eligible studies were included for the analysis,and there were 702 patients in total with diagnosis of malignancies. IIVC clamping was associated with decreased intraoperative CVP. Compared with the anesthesiological control of CVP like fluid restriction,IIVC clamping was better in decreasing blood loss and the requirements for blood transfusion. In addition,IIVC clamping did not increase the incidence of postoperative complications nor impair renal and liver function after surgery. Conclusion： As an alternative,IIVC is efficient in controlling intraoperative blood loss and should be adopted clinically for certain patients undergoing liver resection.

关 键 词：肝下下腔静脉阻断 中心静脉压 术中出血 

分 类 号：R735.7[医药卫生—肿瘤]