肝下下腔静脉阻断与选择性肝静脉阻断在肝切除术中的应用比较  

Comparison of the application between infrahepatic inferior vena cava clamping and selective hepatic venous occlusion in hepatectomy

作　　者：吴超[1] 陈孝平[1,2,3] 喻晶晶[4] 张伟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉430030 [2]华中科技大学同济医学院附属同济医院教育部器官移植重点实验室,武汉430030 [3]华中科技大学同济医学院附属同济医院卫生部器官移植重点实验室,武汉430030 [4]华中科技大学同济医学院附属同济医院转化医学中心,武汉430030

出　　处：《中华肝脏外科手术学电子杂志》2016年第4期244-248,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家科技重大专项(2012ZX10002016-004;2012ZX10002010-001-004);湖北省科技支撑计划(2014BKB089)

摘　　要：目的比较肝下下腔静脉阻断和选择性肝静脉阻断技术在肝切除术中的安全性及有效性。方法回顾性分析2006年1月至2013年12月采用肝下下腔静脉阻断或选择性肝静脉阻断技术行肝切除术的1 952例患者临床资料。患者资料来源于全国100余家医院协作完成的肝切除血流阻断数据库。其中男1 275例,女677例;年龄1~85岁,中位年龄52岁。所有患者均签署知情同意书,符合医学伦理学规定。根据不同的血流阻断方法将患者分为肝下下腔静脉阻断组（1 314例）和选择性肝静脉阻断组（638例）。两组患者术中出血量比较采用Mann-Whitney U检验,术中输血率和术后并发症发生率比较采用χ~2检验。结果肝下下腔静脉阻断组的术中出血量250（10~6 000）ml明显低于选择性肝静脉阻断组的300（10~8 000）ml（U=2.192,P〈0.05）,术中输血率22.8%和术后并发症发生率34.2%明显低于选择性肝静脉阻断组的27.9%、41.2%（χ~2=6.156,9.218;P〈0.05）。结论相比选择性肝静脉阻断,肝切除术中采用肝下下腔静脉阻断技术操作更为简便,可更明显地减少术中出血量,降低术后并发症发生率。Objective To compare the safety and effi cacy between infrahepatic inferior vena cava clamping and selective hepatic venous occlusion in hepatectomy.Methods Clinical data of 1 952 patients who underwent hepatectomy with infrahepatic inferior vena cava clamping or selective hepatic venous occlusion between January 2006 and December 2013 were retrospectively analyzed.The data were derived from the database of hepatic vascular control jointly set up by over 100 hospitals nationwide.Among them,1 275 were males and 677 were females,aged from 1 to 85 years old with a median age of 52 years old.The informed consents of all patients were obtained and the local ethical committee approval was received.The patients were divided into the infrahepatic inferior vena cava clamping group（n=1 314） and selective hepatic venous occlusion group（n=638） according to the different hepatic blood occlusion.The intraoperative blood loss in two groups was compared using Mann-Whitney U test.And the intraoperative transfusion rate and incidence of postoperative complications were compared using Chi-square test.Results The intraoperative blood loss in the infrahepatic inferior vena cava clamping group was 250（10-6 000） ml,signifi cantly less than 300（10-8 000） ml in the selective hepatic venous occlusion group（U=2.192,P〈0.05）.The transfusion rate was 22.8% and the incidence of postoperative complications was 34.2% in the infrahepatic inferior vena cava clamping group,signifi cantly lower than 27.9% and 41.2% in the selective hepatic venous occlusion group（χ2=6.156,9.218;P〈0.05）.Conclusions Compared with selective hepatic venous occlusion,infrahepatic inferior vena cava clamping is more convenient for hepatectomy,and it can more evidently decrease the intraoperative blood loss and reduce the incidence of postoperative complications.

关 键 词：肝切除术 肝下下腔静脉阻断 选择性肝静脉阻断 手术后并发症 

分 类 号：R657.3[医药卫生—外科学]