三种肝血流阻断技术在原发性肝癌合并肝硬化肝切除的对比研究  

Comparative study of 3 kinds of hepatic blood flow occlusion in hepatectomy for primary liver cancer complicated with liver cirrhosis

作　　者：毛岸荣 潘奇 赵一鸣 张宁 周嘉敏 王龙蓉 王益林 林镇海 王鲁 

机构地区：[1]复旦大学附属肿瘤医院肝脏外科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《肝脏》2017年第2期116-118,共3页Chinese Hepatology

摘　　要：目的探讨三种不同肝血流阻断技术在原发性肝癌合并肝硬化手术治疗中的意义。方法回顾性分析因原发性肝癌合并肝硬化行肝切除218例患者的临床资料,其中术中应用Pringle法第一肝门阻断入肝血流65例(A组)、半肝血流阻断76例(B组)、半肝血流阻断加选择性肝静脉控制65例(C组)。比较3组患者肝切除手术时间和术中出血量,术后肝功能恢复以及术后并发症。结果 A、B、C组患者肝切除手术时间分别为(152±18)、(163±21)、(172±23)min,差异无统计学意义(P>0.05);术中出血量分别为(495±76)、(397±64)、(317±65)mL,差异有统计学意义(P<0.01)。在术后2 d和5 d的血清丙氨酸转氨酶[A组:(446±78)U/L与(234±58)U/L;B组:(330±56)U/L与(184±45)U/L;C组:(326±49)U/L与(176±34)U/L]、总胆红素[A组:(56±14)μmol/L与(39±10)μmol/L;B组:(34±10)μmol/L与(23±7)μmol/L;C组:(32±7)μmol/L与(21±9)μmol/L]、前白蛋白[A组:(135±26)mg/L与(166±48)mg/L;B组:(187±35)mg/L与(198±55)mg/L;C组:(196±29)mg/L与(205±41)mg/L]水平比较,B组和C组明显优于A组(P<0.01)。结论针对性左、右半肝血流阻断可防止健侧肝脏缺血再灌注损伤;在手术中选择性肝外控制肝静脉,可显著减少肝切除术中的出血量。Objective To investigate the significance of 3 different hepatic blood flow occlusion techniques in the treatment of primary liver cancer complicated with liver cirrhosis.Methods Clinical data of 218 primary liver cancer patients accompanied with liver cirrhosis who received hepatectomy from March 2015 to March 2016 in our hospital was retrospectively analyzed.Among these patients,Pringle maneuver was performed in77 cases（group A）,hemihepatic blood flow occlusion was performed in 76 cases（group B）and hemihepatic blood flow occlusion and selective hepatic vein control was performed in 65 cases（group C）. Operation time,bleeding,postoperative liver function and postoperative complications were compared among the 3 groups.Results Among the 3 groups,operation time of hepatectomy showed no significant differences（152±18 min vs.163±21 min vs.172±23 min）（P〈0.05）,while mean intraoperative blood losses（495±76 mL vs.397±64 mL vs.317±65 mL）were significantly different（P〈0.01）.At day 2 and 5 after operation,serum alanine aminotransferase,total bilirubin and prealbumin levels in group A were significantly higher than those in group B and C（both P〈0.01）.Conclusion Hemihepatic blood occlusion can prevent systemic hepatic ischemia-reperfusion injury.Selective extrahepatic control of the hepatic vein can significantly reduce bleeding during hepatectomy.

关 键 词：肝细胞癌 肝硬化 肝切除术 第一肝门、半肝血流阻断 肝静脉 

分 类 号：R735.7[医药卫生—肿瘤]