Pringle法与肝下下腔静脉阻断联合Pringle法在肝脏巨大血管瘤切除术中的应用效果评价  

Effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangioma

作　　者：张华安[1] 周晓芳[1] 

机构地区：[1]湖北省天门市中医医院普外科,湖北天门431700

出　　处：《临床肝胆病杂志》2016年第2期317-319,共3页Journal of Clinical Hepatology

摘　　要：目的评价两种不同的入肝血流阻断方式在肝脏巨大肝血管瘤切除术中的应用效果。方法选取2008年1月-2014年12月于天门市中医医院住院的肝脏巨大血管瘤患者20例,将其分为A、B两组,每组10例。A组采用Pringle法进行肝血流阻断,B组采用肝下下腔静脉阻断联合Pringle法阻断入肝血流。比较两组患者的手术时间、肝门血流阻断时间、术中出血量、输血率以及术后肝功能指标。计量资料组间比较采用t检验,计数资料组间比较采用Fisher精确检验。结果两组患者手术时间、肝门血流阻段时间比较,差异均无统计学意义(P值均>0.05);B组患者的术中出血量、输血量及输血率明显低于A组,差异均有统计学意义(P值均<0.05);与A组相比,B组患者术后第3天及第7天的ALT、AST及TBil水平均较低,差异均有统计学意义(P值均<0.05);两组术后并发症发生率差异均无统计学意义(P值均>0.05)。结论肝下下腔静脉阻断联合Pringle法阻断入肝血流在巨大血管瘤切除术中不仅能够减少术中失血量,而且有利于患者术后肝功能的恢复,值得在临床上推广应用。Objective To evaluate the clinical effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangio- ma. Methods A total of 20 patients with giant hepatic hemangioma who were hospitalized in Tianmen Hospital of Traditional Chinese Medi- cine from January 2008 to December 2014 were divided into group A and group B, with 10 patients in each group. Pringle maneuver was ap- plied for group A, and Pringle maneuver combined with inferior vena cava （IVC） clamping was applied for group B. The time of operation, time of portal triad clamping, intraoperative blood loss, blood transfusion rate, and indices for postoperative liver function were compared be- tween the two groups. The t -test was applied for comparison of continuous data, and Fisher＇s exact test was applied for comparison of cate- gorical data. Results The two groups showed no significant differences in time of operation and time of portal triad clamping （ P 〉 0.05 ）, and compared with those in group A, the patients in group B had significantly less intraoperative blood loss and significantly lower volume and rate of blood transfusion （ P 〈 O. 05 ）. Compared with those in group A, the patients in group B had significantly lower levels of aspartate transaminase, alanine transaminase, and total bilirubin on the third and seventh days after surgery （ all P 〈 0.05 ）. However, the incidence of postoperative complications showed no significant differences between the two groups （P 〉 0.05）. Conclusion The method of IVC clam- ping combined with Pringle maneuver can reduce intraoperative blood loss and is beneficial to the recovery of postoperative liver function, and thus it is worthy of clinical promotion and application.

关 键 词：肝肿瘤 血管瘤 阻断疗法 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]