半肝血流阻断前入路半肝切除术的临床应用

Application of anterior approach for hemihepatectomy under occlusion of half hepatic vessel

目的探讨半肝血流阻断前入路半肝切除术在巨块型肝癌中应用的安全性及可行性。方法回顾性分析我院2000年1月～2007年5月半肝切除术43例，其中行半肝血流阻断前入路规则性半肝切除术者为前入路组（n=18），传统的半肝切除术者为传统入路组（n=25）；比较两组患者术中出血量、手术时间、术后肝功能的变化、术后3d总引流量、术后生存时间。结果两组患者手术时间、术中出血量、术后3d总引流量、术后生存时间差异均无统计学意义；而前入路组术后3d和7d的血清谷丙转氨酶、谷草转氨酶、总胆红素水平明显低于传统入路组，而血清前清蛋白高于传统入路组。传统入路组有1例术中死于气体栓塞，术后有2例出现肝功能衰竭，其中1例死亡。前入路组围手术期无死亡。结论对于巨块型肝癌施行半肝血流阻断前入路规则性半肝切除术是安全、可行的，可降低围手术期病死率。

Objective To discuss whether bemihepatectomy using the anterior approach technique for lage hepatocellular carcinoma（ HCC） results in better operative and long-term survival outcomes when compard with the conventional approach technique .Methotis Forty three patients who underwent bemihepatectomy in our hospital from Jan 2000 to May 2007 were retrospectively analyzed. They were divided iuto two groups of the patients who underwent resection of the tumor using the anterior approach technique（ n = 18 ） and the conventional approach technique （ n = 25 ）. The overall operative blood loss, the time of operation, postoperative liver function recovery. total drainae of the first three days after operation and postoperative survival outcomes were compared between the two groups. Results There were no significant difference between the groups in the time of operation total drainage and postoperative survival outcomes. Serum AST,ALT and TBIL in the anterior approach groups were significantly lower than group in 3 and 7 days after operation,while Pre-Albumin was higher than the conventional approach group. One patient in the conventional approach group died of air embolism during operation, two patients suffered from failure of Liver function and the one was died. No patient in the anterior approach group was died during perioperation. Conclusion The anterior approach of hemihepatetomy under occlusion of half hepatic vessel is a safe and effective method to treat the patients with large hepatic cancer and it can reduce the mortality during perioperation.