选择性肝血流阻断技术在肝肿瘤切除术中的应用

Selective hepatic vascular exclusion for hepatectomy

目的探讨选择性肝静脉血流阻断术（SHVE）在复杂肝肿瘤切除术中的有效性和安全性。方法在246例复杂肝肿瘤切除手术中采用选择性肝血流阻断技术，统计分析患者术前一般情况、术中情况、病理诊断、术后并发症等。结果从2000年1月～2007年7月，在复杂肝肿瘤切除手术中246例肿瘤采用了选择性肝血流阻断技术。根据肝血流阻断方法的不同，完全SHVE（阻断第一肝门和所有主肝静脉，Total SHVE）145例，部分SHVE中阻断第一肝门和右肝静脉54例，阻断第一肝门和左中肝静脉47例。3例因术中发现瘤体侵犯下腔静脉壁而改为全肝血流阻断。结果显示血流阻断过程中患者均保持血流动力学稳定，仅外周循环阻力和肺循环阻力轻度升高。术后患者无死亡发生，总并发症率为24．8％，平均住院天数为9．6d。结论选择性肝血流阻断技术是一种安全、有效的血流阻断技术，尤其适合用于位于第二肝门未侵犯下腔静脉的肿瘤切除。

Objective To explore the safety and efficacy df hepatic resection with selective hepatic vascular exclusion （SHVE）. Methods SHVE was used in 246 consecutive patients undergoing major or complex liver resection in our center. Preoperative demographic and clinical data, details of the surgical procedure, pathologic diagnosis, postoperative course and complications were collected and analyzed. Results From January 2000 to July 2007, liver resections were performed under SHVE in 246 patients; total SHVE, right partial SHVE and left partial SHVE in 145, 54 and 47 patients, respectively. SHVE was converted to total hepatic vascular exclusion （THVE） in 3 patients to repair the wall of inferior vena cava （IVC）. Hemodynamic tolerance to SHVE was excellent, only with a slight increase in systemic and pulmonary vascular resistance during clamping. There were no deaths, and the morbidity was 24. 8%. The mean leyth of hospital stay was 9. 6 days （range 8-18 ）. Conclusion Our study showed that SHVE is a safe and effective procedurei and it is applicable to liver tumors near hut not invade the inferior vena cava.