原发性肝癌半肝切除术中不同血流阻断方式的应用研究

A comparative study on vascular blockade during hemihepatectomy for primary hepatic carcinoma

目的研究不同肝脏血流阻断方式在半肝切除治疗原发性肝癌中的应用。方法回顾性分析我院2000-2005年行半肝切除治疗原发性肝癌的相关病例资料。A组:行第一肝门阻断(Pringle法)83例;B组:行Pringle法联合肝下下腔静脉阻断67例;C组:解剖性半肝血流(肝动脉、门静脉及肝静脉)阻断32例。结果手术时间C组较A、B组显著延长(t=3．27、t=2．74,均P<0．01),B组术中肝下下腔静脉阻断后中心静脉压(3．99±1．87)cmH2O,较阻断前(8．32±3．56) cmH2O显著下降(t=8．81,P<0．01);出血量(263±146)ml较A组(657±384)ml显著减少(t= 7．94．P<0．01),并且在肝下下腔静脉阻断后没有发生严重的肾脏及循环系统并发症。C组出血量(255±178)ml较A组显著减少(t=5．68,P<0．01),术后第1天A、B组转氨酶比C组显著升高(t= 8．23、8．56,P<0．01)。结论原发性肝癌行半肝切除术中肝下下腔静脉阻断是一种减少出血的安全有效的简便方法,解剖性半肝血流阻断技术要求高,但可避免肝脏缺血再灌注损伤,术中肝损伤也小。

Objective To compare among three different methods in performing hepatic vascular blockade during hemihepatectomy for primary hepatic carcinoma（PHC）. Methods Between 2000 and 2005, 83 PHC patients underwent the Pringle＇s maneuver （Group A）, 67 cases in combination Pringle＇s maneuver and inferior vena cava （IVC） clamping （ Group B） , and 32 cases received anatomical blood flow blockade for the half liver for hemihepatectomy （ Group C ）. Results Operation time in group C was longer than that in group A and B（ t = 3.27,2.74, all P 〈 0. 01 ）. Central venous pressure （CVP） decreased significantly from （8.32±3.56） cmH2O to （3.99 ± 1.87） cmH2O after IVC clamping （t =8.81,P 〈 0.01）. Blood loss was （263-＋146） mlingroup Band （657±384） mlin group A （t=7.94,P〈0.01）. There was no severe renal or cardiovascular damage occurred after IVC clamping. Blood loss in group C （255± 178） ml was significantly less than that in group A （657±384） ml （t = 5.68 ,P 〈 0. 01 ）. ALT and AST level one day after operation in both group A and B were significantly higher than that of group C（ t = 8. 23,8.56,P 〈 0. 01 ）. Conclusions IVC clamping is effective and safe in reducing blood loss during hemihepatectomy. Anatomical hemihepatectomy in which blood flow was blocked before the resection caused no liver ischemia-reperfusion injury, though it demands a longer operation time.