三种不同肝血流阻断方式在肝肿瘤切除术中的应用

The Application of the Three Different Modes of Liver Blood Flow Blockade with Liver Tumor Excision

目的探讨3种不同肝血流阻断方式在肝肿瘤切除术中的应用。方法将74例肝肿瘤患者根据肝血流阻断方式分为3组:A组(n=40)行pringle法,B组(n=23)行全肝血流阻断(THVE),C组(n=11)行解剖性肝血流(肝动脉、门静脉及肝静脉)阻断。并观察3组肝血流阻断时间、手术时间、出血量及并发症等情况。结果A组和B组手术时间均较C组显著缩短(均P<0.01),B组肝门阻断前1 min和肝门开放后1 min中心静脉压均显著高于肝门阻断后(均P<0.01),B组和C组出血量均较A组显著减少(均P<0.01),A组和B组术后3 d ALT、AST水平均较C组显著升高(均P<0.01),3组肝血流阻断后均未发生肾脏及心血管系统并发症。结论肝肿瘤行肝切除术时行pringle法血流阻断是一种简便方法,但出血量多;全肝血流阻断是一种减少出血的有效方法;解剖性肝血流阻断技术要求高,但术中肝损伤小,可避免缺血-再灌注损伤。

Objective To explore the application of three different modes of liver blood flow blockade for resection of liver cancer. Methods Seventy-four patients underwent different mode of liver blood flow blockade were randomly divided into 3 groups： group A（n=40） received the Pringle＇s,group B（n=23） received THVE and group C（n= 11） received anatomical blood flow blockade for the liver（Hepatic artery,portal vein and hepatic vein）. And catched on 3 groups of liver blood flow blockade time, operation time, amount of bleeding and complications, etc. Results The operation time of Group A or group B was significantly shortened than those of group C （P〈0.01, respectively）. Central venous pressure of 1 min before hepatic Portal triad clamping and 1 min after the opening of hepatic portal of goup B were significantly higher than that after hepatic portal blockade（P〈0.01, respectively）. The amount of bleeding in Group 13 or group C was significantly reduced than those in group A （P〈0.01 ,respectively）,3 days later ALT,AST level in group A or group B was significantly higher than those in group C （P〈0.01 ,respectively）,liver blood flow blockade group 3 did not happen after the kidney and cardiovascular complications. Conclusions The pringle is a simple method, but more amount of bleeding. Total liver blood flow blockade is a effective method and reducing loss of blood in resection of liver cancer. Anatomical of liver blood flow blockaed request higher technique,with small injury of liver and a- void ischemia-reperfusion injury.