选择性入肝血流阻断在腹腔镜肝切除术中的应用  

The application of selective hepatic inflow occlusion on laparoscopic liver resection

作　　者：窦春青[1] 孙丽媛[1] 金鑫[1] 韩明明[1] 张宝[1] 王大东[1] 王有龙[1] 李涛[1] 

机构地区：[1]解放军总医院第一附属医院肝胆外科,北京100048

出　　处：《中国医学前沿杂志（电子版）》2017年第1期135-138,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨选择性入肝血流阻断在腹腔镜肝切除术中的临床效果,并与全入肝血流阻断法进行比较。方法选取2010年1月至2015年12月于本院进行阻断肝门血流后腹腔镜肝切除术的62例患者为研究对象,根据术中血流阻断方式将其分为对照组(间断性全入肝血流阻断)和观察组(选择性入肝血流阻断)。比较两组患者的手术时间、术中出血量、术后住院天数、术后肝功能指标及并发症发生率。结果两组患者术中出血量、手术时间、术后住院天数比较差异均无显著性(P>0.05)。术后1、3、7天,观察组患者谷丙转氨酶和谷草转氨酶水平均低于对照组(P<0.05),前白蛋白水平均高于对照组(P<0.05),两组患者白蛋白、总胆红素及直接胆红素水平比较均无显著差异(P>0.05)。两组患者术后并发症发生率比较无显著差异(P>0.05)。结论在腹腔镜肝切除术中,选择性肝门血流阻断能够取得与全入肝血流阻断相同的控制入肝血流及降低出血量的效果,且对肝功能的保护作用优于后者。Objective To investigate the clinical effect of selective hepatic inflow occlusion on laparoscopic liver resection, and compare with total hepatic blood flow occlusion. Method Selected 62 patients who were subject to laparoscopic liver resection by hepatic inflow occlusion from January 2010 to December 2015 in our hospital, they were devided into two groups by intraoperative blood flow. Control group patients were treated with intermittent total hepatic inflow occlusion, and observation group patients were treated with selective hepatic inflow occlusion. Operation time, amount of bleeding during operation, postoperative hospital day, liver function and postoperative complication rate were compared between the two groups. Result There were no significant differences in amount of bleeding during operation, operation time and postoperative hospital day between the two groups（P〉0.05）. The concentration of ALT and AST of observation group were lower than control group on the first, third and seventh postoperative day respectively（P〈0.05）, the level of PA was higher than control group（P〉0.05）, There were no significant differences in the levels of albumin, total bilirubin and direct bilirubin between the two groups（P〉0.05）. There was no significant difference in the incdence of postoperative complications between the two groups（P〉0.05）. Conclusion Both of the selective hepatic inflow and total hepatic inflow occlusion can control liver blood flow and decrease bleeding on laparoscopic liver resection. Moreover, the selective hepatic inflow can protect liver function better.

关 键 词：腹腔镜 肝切除 选择性入肝血流阻断 

分 类 号：R657.3[医药卫生—外科学]