肝静脉阻断技术在肝切除术中的应用

Hepatic veins exclusion during the process of hepatectomy

目的探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用。方法对71例肝脏肿瘤手术切除病例施行了1根以上主肝静脉阻断。所有肿瘤均位于第二肝门并侵犯或压迫1根以上主肝静脉。肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法。结果71例中无1例肝静脉分离破裂,行肝静脉结扎28例,血管带阻断26例,血管夹阻断17例;阻断右肝静脉34例,右肝静脉+中肝静脉2例,左、中肝静脉共干24例,左、中肝静脉分干2例,左、中、右三干9例。施行半肝全血流阻断35例(右侧24例,左侧11例)。交替半肝全肝血流阻断4例,第一肝门阻断加部分肝静脉阻断23例。第一肝门阻断加全部肝静脉阻断(不阻断下腔静脉的全肝血流阻断)9例。71例肝肿瘤均顺利切除。结论肝静脉阻断技术是一种安全、有效的血流阻断技术。不阻断下腔静脉的全肝血流阻断术既能控制术中出血,又能保证全身血流动力学稳定。

Objective To evaluate hepatic veins exclusion for the prevention of massive bleeding and air embolism during hepatectomy. Methods Seventy-one cases of liver tumours underwent hepatectomy with more than one major hepatic vein branches being temporarily clamped, All the turnouts involved the second porta hepatis and at lest one main hepatic veins. Serrefine, tourniquet and auricular clamp were used for hepatic vein exclusion. Results Of the 71 patients, tumor involved hepatic veins were ligated in 28 cases, temporarily blockaded with tourniquet in 26 cases, and with serrefine in 17 cases. Right hepatic veins were temporarily occluded in 34 cases, both right and middle hepatic veins in 2, common trunk of left and middle hepatic veins in 24, branchs of left and middle hepatic veins in 2, total hepatic veins in 9 cases. Thirty-five cases underwent hemihepatic vascular occlusion, and 4 with alternative hemihepatic vascular occlusion, Pringle＇s maneuver and partial hepatic veins occlusion were adopted in 23 cases, Pringle＇s maneuver and total hepatic veins occlusion were used in 9, All the turnouts were removed completely and successfully. Conclusion Hepatic veins occlusion for hepatectomy is safe, effective to prevent dangerous bleeding and air embolism with less interference to hemodynamics than total hepatic blood occlusion.