Pringle′s法联合肝静脉阻断技术在复杂肝切除术中的应用

Application of pringle maneuver combined with hepatic veins occlusion in complicated hepatectomy

目的探讨Pringle’s法联合肝静脉阻断技术在复杂肝切除术中的应用价值。方法对37例第二肝门区肿瘤施行Pringle’S法＋肝静脉阻断切肝术患者的临床资料进行回顾性分析。结果37例患者中原发性肝癌27例，转移性肝癌2例，肝巨大血管瘤8例。肿瘤平均直径12．7cm（6～35cm）。肿瘤侵犯1根主肝静脉6例，侵犯2根主肝静脉20例，侵犯3根主肝静脉11例。行右三叶切除11例，右半肝切除5例，中肝叶切除9例，Ⅷ段切除4例，左三叶切除5例，尾状叶切除3例。平均第一肝门阻断时间29min（17～4gmin），平均肝静脉阻断时间21min（8～32min）。行肝静脉修补1例。平均术中出血量950mL（200-4000mL）。全组术后发生并发症18例次，均经治疗后愈。无死亡病例。结论Pringle’S法联合肝静脉阻断技术在复杂肝切除术中既能达到减少术中出血的目的，又能防止术中肝静脉破裂导致空气栓塞，还避免了下腔静脉阻断所引起全身血流动力学紊乱，是一种更安全、有效的血流阻断技术。

Objective To evaluate the effect of application of pringle maneuver combined with hepatic veins occlusion in the process of hepatectomy. Methods The clinical data of 37 cases of tumours that involved the second portal hepatis and underwent liver resection were surveyed retrospectively. Pringle maneuver combined with hepatic veins occlusion was used during the resections. Results In this series, there were 27 cases of hepatoceUuar carcinoma, 2 cases of metastatic liver tumor, and 8 giant haemangioma. The average size of the tumors was 12.7 cm （ 6 cm to 35 cm ） in diameter. One main hepatic vein was invaded by tumor in 6 cases, 2 main hepatic veins were invaded by tumor in 20 cases and 3 main hepatic veins were invaded in 11 cases. Among the 37 hepatectomies, extended right hepatectomy was performed in 11 patients, right hemihepatectomy in 5, middle lobe hepatectomy in 9, extended left hepatectomy in 5, resection of segment Ⅷ in 4 and caudate lobectomy in 3 cases. The mean occlusion time of the first porta hepatis was 29 min （ 17 min -48 min ） , and occlusion time of the hepatic veins was 21 min （8 min -32 min ）. The average blood loss was 950 ml （200ml 4000ml ）. Postoperative complications occurred on 18 occasions, and all recovered after treatment. There was no mortality in this series. Conclusions Pringle maneuver combined with hepatic veins occlusion for complicated hepatectomy is safe, and is effective to prevent dangerous bleeding and air embolism with less disturbance of systemic hemodynamics.