肝脏流域学说下的控血新理念:适时分合肝脏控血技术  

A new blood controlling concept based on the dynamic liver blood watershed theory:cross interface blood control maneuver

作　　者：赵国栋[1] 马奔 刘荣[1] Zhao Guodong;Ma Ben;Liu Rong(Faculty of Hepato-Biliary-Pancreatic Surgery,Chinese People′s Liberation Army(PLA)General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院肝胆胰外科医学部,北京100853

出　　处：《中华医学杂志》2021年第40期3261-3265,共5页National Medical Journal of China

基　　金：国家重点研发计划(2017YFC0110405)。

摘　　要：肝脏血供丰富,质地软脆,其切除手术需要确切且安全的出血控制技术。全入肝血流阻断法控血确切但是副损害大,阻断时间有限,解剖性入肝血流阻断副损伤较小,但是在实践过程中存在保留侧肝断面出血较多现象。基于肝血流流域学说,肝段/叶切除界面间存在交通血流即血流交汇带,此为解剖性入肝血流阻断效果不佳原因。实时分合控血技术,针对不同术式,单用或联用多种控血手段,核心特色是控制肝切除界面的血流交汇带处血流,更符合肝脏术中会出现交通血流的特点,因此较解剖性入肝血流阻断能够很好的控制出血,同时减轻全入肝血流阻断的多种副损伤。Liver is rich in blood supply,with soft and crisp texture,therefore its resection requires accurate and safe bleeding control techniques.The hemostatic effect of complete hepatic inflow occlusion is complete,but the side effects are comparatively serious and the blocking time is limited.The side effects of anatomical hepatic inflow occlusion are light,but there is more bleeding in the process of practice,especially the bleeding of the preserved side of the liver.Based on the dynamic watershed theory,there is traffic flow between hepatic segments and lobes,which is the reason for the poor effect of anatomic hepatic blood flow occlusion.We propose cross interface blood control maneuver.In this strategy,we use a variety of blood control methods alone or in combination,to control the borderline blood flow between segments/lobes.Therefore,compared with anatomic hepatic blood flow occlusion,this strategy can control bleeding well and reduce various side effects of total hepatic blood inflow occlusion.

关 键 词：肝 肝脏切除术 血流控制技术 肝脏分段 PRINGLE法 

分 类 号：R657.3[医药卫生—外科学]