改良式绕肝提拉法半肝切除的临床应用研究

Modified liver hanging maneuver in the application of hemihepatectomy

目的探讨改良绕肝提拉法（liver hanging maneuver）半肝切除的临床实用性和安全性。方法将24例行半肝切除术的患者分为两组：改良式绕肝提拉法半肝切除组12例，Pringle＇s阻断法半肝切除组12例。比较两种半肝切除方法的术中失血量、手术时间、术后肝功能及并发症发生率等指标。结果两组均顺利完成手术，两组手术时间相比差异无统计学意义。术中平均失血量，改良组为（160±40）ml，Pringle＇s组为（560±120）ml，差异有统计学意义（P〈0．01）。术后第3天和第7天肝功能（ALT、AST、TB）测试数据，改良半肝切除组优于全肝入肝血流阻断组，差异有统计学意义（P〈0．01）。术后改良半肝切除组的腹腔引流量、住院时间和并发症均少于全肝入肝血流阻断组，其中腹腔引流量统计两组差异有统计学意义（P〈0．01）。结论改良式绕肝提拉法半肝切除是安全实用的。

Objective To evaluate a modified liver hanging maneuver （retrohepatic tunnel of the IVC ） in patients undergoing hemihepatectomy. Methods Twenty-four patients undergoing hemihepatectomy were divided into two groups： modified liver hanging maneuver group （n = 12 ） and Pringle＇s maneuver group （ n = 12 ）. The amount of intraoperative bleeding, operation time, postoperative liver function, liver function recovery and complications were compared between the two groups. Result All operation were performed successfully and there were no difference in the time of operation between the two groups. There was a difference in the amount of mean intraoperative blood loss between the two groups. It was （ 160 ± 40 ） ml in liver hanging group and （ 560 ± 120 ） ml in Pringle＇ s group （ P 〈 0. 01 ）. Liver function recovery measured on postoperative day 3 and day 7 was better in liver hanging group than that in Pringle＇s group （P 〈0. 01 ）. The volume of postoperative peritoneal serous fluid dranage was significantly less in liver hanging group （P 〈 0. 01 ）. Conclusion The modified liver hanging maneuver is useful for hemihepatectomy.