不阻断入肝血流肝切除术

Hepatectomy without Employment of Pringle Maneuver

目的 :探讨不阻断入肝血流肝切术手术的安全性及技巧。方法 :分析不阻断入肝血流的肝切除术 39例 ,其中男性 31例 ,女性 8例。术前肝功按Child分级 :A级 34例 ,B级 5例。肿瘤直径 3～ 15cm。手术方式 :半肝切除术 5例 ,中央型肝切除术 9例 ,周边型肝切除术 2 5例。主要用钳夹法和指折法相结合的方式断肝 ,必要时利用术中B超判断切除范围和肿瘤与肝内血管的关系。观察术后并发症发生率、术中输血量、手术时间等指标。结果 :手术时间 80～ 4 80分钟 ,术中输血量 0～ 76 0 0ml,术中平均输血量 112 0 +980ml,术后并发症发生率17 9% (7/39) ,术后无肝衰发生。结论 :本组资料显示应用不阻断入肝血流切肝可行、安全。

Objective:To investigate the safety and surgical technique of hepatectomy without Pringle maneuver in patients with hepatoma.Methods:The 39 patients with hepatoma received hepatectomy without Pringle maneuver.The clinical character of the 39 patients with hepatoma were 8 females and 31 males.The age years was 28-67 year old.According Child's statues before operation:class A in 34 patients and class B in 5 patients,the tumor size in diameter was 3-15cm.Of them the 35 patieats,5 patients with hepatoma underwent hemihepatectomy,9 case resection of the middle lobe of the liver and 25 resection the marginal lobe of the liver.The way of parenchymal transection was applied with clips and finger fracture.B-ultrasonic examination was used to determine the resected edge of the tumor or the relationship of tumor and hepatic vein in liver during operation.Results:Total operative time was 80-480 minutes,blood loss was 0-7600ml and blood transfusion was 1120±980ml.Postoperative complication rate accounted for 17.9%(7/39).The liver failure was not observed in the postoperative patients.Conclusion:Our clinic data showed that hepatectomy without Pringle maneuver in the patients with hepatoma was safe and feasible.