控制性第一肝门阻断法在肝切除手术中的安全性和有效性  

Safety and efficacy of the controlled first hepaticportal blood flow occlusion in hepatectomy

作　　者：夏俊[1] 贾冉[1] 钱叶本[1] 许业传[1] 张超[1] Xia Jun;Jia Ran;Qian Yeben;Xu Yechuan;Zhang Chao(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院肝胆外科,合肥230032

出　　处：《中华肝胆外科杂志》2021年第12期889-893,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省自然科学基金重点研究与开发计划项目(201904a07020047)。

摘　　要：目的研究控制性第一肝门阻断法在肝切除手术中的安全性和有效性。方法前瞻性纳入2018年9月1日至2020年9月1日在安徽医科大学第一附属医院肝胆外科行肝脏切除手术的患者作为研究对象。共纳入203例患者,其中男性133例,女性70例,年龄(52.9±19.2)岁。随机数表法将纳入患者分为3组:接受间断式Pringle第一肝门阻断法者72例为Pringle阻断组;接受控制性第一肝门阻断法者66例为控制性阻断组;接受单纯门静脉阻断法者65例为门静脉阻断组。分析比较3组患者断肝出血量、总手术时间、术后肝功能指标、术后住院时间及并发症等临床资料。结果门静脉阻断组的断肝出血量(226.7±117.9)ml多于Pringle阻断组(115.7±84.2)ml和控制性阻断组(128.1±103.6)ml,总手术时间(173.6±51.7)min长于Pringle阻断组(128.4±36.5)min和控制性阻断组(136.1±40.7)min,差异有统计学意义(均P<0.05)。术后第1天Pringle阻断组患者的天冬氨酸氨基转移酶(AST)水平(587.5±189.2)U/L高于控制性阻断组(361.2±158.3)U/L和门静脉阻断组(358.2±162.7)U/L,丙氨酸氨基转移酶(ALT)水平(609.4±172.5)U/L高于控制性阻断组(414.8±162.2)U/L和门静脉阻断组(395.6±158.7)U/L,差异有统计学意义(均P<0.05)。术后第3天Pringle阻断组的AST和ALT水平均下降,但仍然高于控制性阻断组和门静脉阻断组,差异有统计学意义(均P<0.05)。3组患者肝功能指标、术后住院时间及并发症发生率间差异无统计学意义(均P>0.05)。结论间歇性Pringle法肝门阻断、控制性第一肝门阻断和门静脉阻断三种入肝血流阻断方式均是安全有效的,控制性第一肝门阻断方法更简便,且对减轻肝缺血再灌注损伤有一定保护作用。ObjectiveTo determine the safety and efficacy of controlled first hepaticportal blood flow occlusion in hepatectomy.MethodsPatients who underwent hepatectomy from 1 September 2018 to 1 September 2020 at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University were studied.There were 133 males and 70 females,with age of(52.9±19.2)years old.They were prospectively randomized into three groups:the intermittent Pringle’s maneuver group(n=72),the controlled first hepaticportal blood flow occlusion group(n=66)and the selective portal vein occlusion group(n=65).The clinical data of these three groups before,during and after operation were analysed.ResultsThe amount of intraoperative bleeding in the selective portal vein occlusion group was significantly more than the intermittent Pringle’s maneuver group[(226.7±117.9)vs.(115.7±84.2)ml,P<0.05]and the controlled first hepaticportal blood flow occlusion group[(226.7±117.9)vs.(128.1±103.6)ml,P<0.05].The total duration of operation in the selective portal vein occlusion group was significantly longer than the intermittent Pringle’s maneuver group[(173.6±51.7)vs.(128.4±36.5)min,P<0.05]and the controlled first hepaticportal blood flow occlusion group[(173.6±51.7)vs.(136.1±40.7)min,P<0.05].The postoperative data showed the AST indexes on day 1 after surgery to be significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group[(587.5±189.2)vs.(361.2±158.3)U/L,P<0.05],and the selective portal vein occlusion group[(587.5±189.2)vs.(358.2±162.7)U/L,P<0.05].The ALT indexes on day 1 after surgery were significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group[(609.4±172.5)vs.(414.8±162.2)U/L,P<0.05],and the selective portal vein occlusion group[(609.4±172.5)vs.(395.6±158.7)U/L,P<0.05].The AST and ALT indexes on day 3 after surgery were significantly different

关 键 词：肝切除术 再灌注损伤 入肝血流阻断 

分 类 号：R657.3[医药卫生—外科学]