选择性出入肝血流阻断在肝脏巨大肿瘤切除术中的应用

Selective exclusion of hepatic outflow and inflow in hepatectomy for huge hepatic tumor

目的探讨选择性出入肝血流阻断（SHVE）在肝脏巨大肿瘤切除术中应用的优势。方法回顾性分析29例施行肝脏巨大肿瘤切除术患者的临床资料，随机分为SHVE组（15例）和第一肝门阻断组[（Pringle组），14例]，比较两组患者的术中肝血流阻断时间、肝切除范围、出血量、术后肝功能恢复情况、术后2d平均腹腔引流量以及并发症发生率等指标。结果两组患者的性别、年龄、肿瘤大小、术中肝血流阻断时间以及肝切除范围的差异均无统计学意义（P〉0．05）。SHVE组患者的术中出血量为（282．1±286．5）ml，明显少于Pringle组[（721．5±512．1）ml，P〈0．05]。SHVE组患者术后第1、3、7天血清前白蛋白含量明显高于Pringle组（P〈0．05），血清谷丙转氨酶和总胆红素含量明显低于Pringle组（P〈0．05）。SHVE组患者术后2d平均引流量为（189．4±103．5）ml，明显少于Pringle组[（249．5±108．7）ml，P〈0．05]。Pringle组有1例发生肝功能衰竭，SHVE组无一例发生肝功能衰竭。Pringle组有4例发生肝静脉损伤，3例发生肝静脉破裂大出血，1例发生空气栓塞；SHVE组虽有5例发生肝静脉损伤，但无一例发生肝静脉破裂大出血或空气栓塞。结论SHVE术可以提高肝脏巨大肿瘤切除患者对手术的耐受性，是合理安全的肝脏手术术式。

Objective To evaluate the effects of selective hepatic vascular exclusion （SHVE） on prevention of serious hemorrhage and air embolism during hepatectomy and on the liver function after operation. Methods From January 2004 to March 2007, 29 huge hepatic tumors were resected in our department. Both SHVE and Pringle maneuver were used to control the blood loss during hepatectomy. They were divided into two groups： SHVE group （ 15 cases） and Pringle group （ 14 cases）. Data regarding the intraoperative and postoperative courses of the patients were analyzed. Results There was no significant difference between the two groups regarding the age, sex, tumor size, cirrhosis, HbsAg positive rate and operating time （P 〉 0.05 ）. Intraoperative blood loss was reduced significantly in the SHVE group （P 〈 0.05）. The sertun prealbumin levels on the postoperative day 1, 3 and 7 in SHVE group were significantly higher than those in the Pringle group （ P 〈 0.05 ）. The serum ALT value in SHVE group was significantly lower than that in the Pringle group on postoperative day 1, 3 and 7. The mean drainage volume in SHVE group was significantly less than that in the Pringle group on postoperative day 1 and 2. Liver failure occurred in two cases of the Pringle group, while no one in the SHVE group. Rupture of hepatic vein with massive blood loss occurred in 3 cases and air embolism in one case of the Pringle group, but did not occur in any case of the SHVE group. Conclusion When the selective exclusion of hepatic outflow and inflow is applied in hepatectomy, the resection rate of huge hepatic tumors and operative tolerance of hepatectomy are improved. It is a safe and rational operation type, and provides an optimal choice for hepatectomy.