肝硬变病人肝切除时的肝脏血供阻断

HEPATIC VASCULAR OCCLUSION FOR LIVER RESECTIONIN CIRRHOTIC PATIENTS

１９８１年４月～１９９３年１月，作者为５９例原发性肝癌合并肝硬变病人施行肝切除手术时，采用常温下持续性肝门血供阻断６３例次（４例病人曾施行两次手术），其中急症手术４例次，择期手术５９例次。择期手术中，术前肝功能属ＣｈｉｌｄＡ级者３９例次，Ｂ级１３例次，Ｃ级４例次，不明３例次。肝门阻断时间为５～４１分钟（中位时间为２５分钟），７６％的病人超过２０分钟，２５．４％超过３０分钟。大量肝切除４５例次（７１．４％），小量肝切除１８例次（２８．６％）。术中失血量为１００～４００Ｏｍｌ（中位数６００ｍｌ），８４．２％少于１０００ｍｌ，５６．１％在６００ｍｌ以内。术后死亡４例，死因与肝门阻断时间无关（ｐ＞０．５）。另１０例术后发生肝功能失代偿，亦与肝门阻断时间无关（Ｐ＞０．５）。作者认为，硬化肝脏可耐受常温下缺血２０～３０分钟或更长时间。

ince 1981 ,continuous normothermic hepatic vascular occlusion for liver re-section was applied in 63 operations , for 59 patients with primary hepatic carci-noma combined with cirrhosis (4 patients underwent 2 operations) , including 4emergency and 59 selective operations- According to Child classification, therewere 39 patients in class A, 13 in class B, 4 in class C, and 3 not determined inthe selective group before operation. The duration of hepatic ischemia variedfrom 5 to 41 minutes , (median 25 minutes) , 76% of hepatic occlusion were morethan 20 minutes, 25. 4% more than 30 minutes. Major liver resection was per-formed in 35 operations (71. 4%) , minor liver resection in 18 (28. 5%). Theblood loss during operation varied from 100 to 4000ml (median 600ml) ; in 84.2% of the operations were less than 1000ml; 56. 1% less than 600ml. Four pa-tients died postoperatively, but the causes of death had no relationship with theduration of hver ischemia (P>0. 5). Decompensation of liver function was foundin 10 patients after operation, which also had no relationship with the durationof hepatic ischemia (P>0. 5). It is concluded that cirrhotic liver can toleratenormothermic ischemia for 20 to 30 minutes or a little more.