保持下腔静脉通畅的全肝血流阻断切肝术

Total hepatic vascular exclusion with preservation of caval flow for hepatectomy

目的探讨保持下腔静脉通畅的全肝血流阻断切肝术（THVEPC）的应用价值。方法对25例位于第二肝门区肿瘤施行第一肝门＋左、中、右肝静脉阻断切肝术，保持下腔静脉血流畅通，11例病人同时行肝短静脉结扎。结果25例病人中原发性肝癌17例、转移性肝癌1例、肝母细胞瘤2例、肝巨大血管瘤5例。肿瘤直径14．7cm（5～43cm）。肿瘤侵犯2根主肝静脉16例，侵犯3根主肝静脉9例。行右三叶切除7例，右半肝切除3例，中肝叶切除6例，Ⅷ段切除3例，左三叶切除4例，尾状叶切除2例。共结扎肝静脉16根，血管带阻断20根，血管夹或心耳钳阻断18根。切断1根主肝静脉14例，切断2根主肝静脉11例。平均第一肝门阻断时间25．5min（15～42min），平均肝静脉阻断时间16．4min（5～28min）。平均术中出血量820ml（100～6000ml）。行肝静脉修补4例。结论保持下腔静脉通畅的全肝血流阻断切肝术既能达到无血切肝的目的，又避免了下腔静脉阻断所引起全身血流动力学紊乱，是一种更符合生理的新技术。

Objective To investigate the effect of total hepatic vascular exclusion with preservation of caval flow （THVEPC） on resection of liver tumors. Methods Twenty-five patients with tumors involving the second prota hepatis underwent liver resection. Pringle＇s maneuver in combination with left, right and middle hepatic vein exclusion was used during the resection, without interrupting the flow in the inferior vena cava （IVC）. The short hepatic veins were also transected and tied in 11 patients. Results Of the 25 patients, 17 were with hepatocellular carcinoma, 1 second malignancy, 2 hepatoblastoma and 5 giant hemangioma. The tumors were of a average of 14.7 cm （5-43 cm） in diameter. Two main hepatic veins were invaded by tumors in 16 patients and 3 main hepatic veins were invaded in 9. Extended right bepatectomy was performed in 7 patients, right hemihepatectomy in 3, middle lobectomy in 4, extended left hepatectomy in 4, resection of segment Ⅷ in 3 and caudate lobectomy in 2. During the resection, 16 hepatic veins were ligated, exclusion with tourniquet in 9, with serrefine or auricular clamp in 5. One main hepatic vein was transected and tied in 14 patients, 2 main hepatic veins were treated likewise in 11. The mean occlusion time of the first porta hepatis was 22.5 min （15-42 min） and that of the hepatic veins 16.4 min （5-28 min）. The blood loss was 820 ml （100-6000 ml）. Hepatic vein neoplasty was performed in 4 patients. Conclusion THVEPC for hepatectomy is more reasonable to perform with better hemodynamics and bleeding control.