区域性肝血流阻断在肝切除术中的应用

Regional Hepatic Vascular Exclusion in Hepatectomy

目的:总结区域性肝血流阻断行肝切除的经验。方法:回顾分析46例区域性肝血流阻断行肝切除的临床疗效。左半肝切除6例,左肝外侧叶切除17例,右半肝切除4例,右肝多肝段联合切除6例,肝段或不规则肝段切除13例。区域性肝血流阻断的方式包括导尿管束扎法18例,肠钳夹压法22例,经肝后隧道绕肝带束扎提拉法6例。结果:本组病例无死亡。术中输血3例,平均出血量210mL;术后并发膈下感染1例,胆瘘2例,胸腔积液2例,切口感染3例。结论:区域性肝血流阻断下进行肝切除是一种简便、安全且有效的方法,能有效控制术中肝脏出血,减轻术后肝功能损害。

Objective To evaluate the effect of regional hepatic vascular exclusion in hepatectomy. Methods Clinical data of forty - six patients underwent hepateetomy with regional hepatic vascular exclusion were analyzed. Operation methods included left hemi - hepatectomy in 6 patients, left lateral lobectomy in 17 patients, fight hemi - hepatectomy in 4 patients, combined right segmentectomy in 10 patients and regular or irregular segmentectomy in 13 patients. There were three methods, urethral catheter binding maneuver in 18 patients, intestinal forceps clamping maneuver in 22 patients and liver hanging maneuver in 6 patients. Results There was no operative mortality. Three patients needed operative blood transfusion.The average blood loss was 210 mL. The major complications were subphrenic infection in 1 ease, bile leakage in 2 cases, hydmthorax in 2 cases and wound infection in 3 cases. Conclusions Regional hepatic vascular exclusion is not only a safe and feasible method in the procodure of hepateetomy, but also it could prevent massive bleeding in liver resection and reduce the incidence of postoperative liver failure.