半肝血流阻断法与肝门阻断法在肝切除术中的应用效果比较  

Comparison between hemihepatic vascular occlusion and Pringle maneuver occlusion in hepatectomy for primary hepatocellular carcinoma

作　　者：黄效廷[1] 陈远雷 何文海[1] HUANG Xiao-ting;CHEN Yuan-lei;HE Wenhai(Department of Hepatobiliary Surgery,the People′s Hospital of Linshan County,Guangxi 535400,China)

机构地区：[1]灵山县人民医院肝胆外科,广西535400

出　　处：《中国临床新医学》2018年第4期381-384,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的探讨不同血流阻断方案在原发性肝细胞癌患者手术中的效果,为肝切除术中最佳血流阻断方式的选择提供参考。方法回顾性分析2010-06~2017-06肝细胞癌行开腹肝部分切除患者78例,按手术中肝血流阻断方式分为两组:A组(半肝血流阻断)40例,B组(Pringle法肝门阻断)38例。对两组患者手术时间、术中出血量、术中血流阻断时间、术后血清丙氨酸转氨酶水平、术后早期并发症情况进行比较。结果A组中位手术时间为160.5 min,中位失血量为498.2 ml,中位血流阻断时间为33.7 min,B组依次为155.3 min、512.0 ml和31.6 min,两组差异无统计学意义(P>0.05)。A组术后第1天、第3天、第7天的丙氨酸转氨酶水平低于B组(P<0.05)。A组发生术后并发症5例(12.5%),其中胆瘘1例,肝断面出血1例,胸腔积液2例,切口感染1例。B组发生术后并发症8例(21.1%),其中胆瘘2例,胸腔积液3例,大量腹水3例。两组术后早期并发症发生率比较差异有统计学意义(P<0.05)。结论半肝血流阻断法较传统Pringle法肝门阻断法在原发性肝细胞癌患者手术中可以减轻术后肝功能损害,降低并发症发生率,是肝癌肝切除术中一种安全、有效的血流控制方法,值得临床推广应用。Objective To investigate the effect of different blood flow blocking protocols on primary hepatocellular carcinoma,and to provide the reference for the choice of optimal blood flow interruption during hepatectomy.Methods Seventy-eight hepatocellular carcinoma patients who underwent open hepatectomy from June 2010 to June 2017 in our hospital were enrolled.The patients were divided into two groups according to the different intraoperative hepatic blood occlusions:group A(hemihepatic vascular occlusion,n=40)and group B(pringle maneuver occlusion,n=38).The operation time,intraoperative blood loss,intraoperative blood flow interruption time,serum level of alanine aminotransferase and early postoperative complications were compared between the two groups.Results There were no significant differences between group A and group B in the median operative time(160.5 vs 155.3 minutes),the median blood loss(498.2 vs 512.0 ml)and the median occlusion time(33.7 vs 31.6 minutes)(P>0.05).The levels of alanine aminotransferase in group A on the first,third and seventh day after operation were significantly lower than those in group B(P<0.05).In group A,the postoperative complications occurred in 5 cases(12.5%),including 1 case with biliary fistula,1 case with liver section hemorrhage,2 cases with pleural effusion and 1 case with incision infection.In group B,the postoperative complications occurred in 8 cases(21.1%),including 2 cases with biliary fistula,3 cases with pleural effusion and 3 cases with ascites.There was a significant difference in the incidence of early postoperative complications between the two groups(P<0.05).Conclusion Compared with Pringle maneuver occlussion,hemihepatic vascular occlussion can reduce the damage of postoperative liver function and reduce the complications in the patients with primary hepatocellular carcinoma.Hemihepatic vascular occlusion is a safe and effective blood flow control method in hepatectomy.

关 键 词：半肝血流阻断法 原发性肝细胞癌 肝切除术 效果 

分 类 号：R735.7[医药卫生—肿瘤]