双绕肝提拉法在半肝切除中的应用价值

Double liver hanging maneuver in hemihepatectomy

目的探讨和完善建立肝后隧道的方法及双绕肝提拉在半肝切除术中的应用价值。方法采用胆道探条代替血管钳建立肝后隧道，并预置2根绕肝带。施行双绕肝提拉前入路法行半肝切除术38例患者为提拉组，用传统方法行半肝切除的89例患者为对照组，比较双绕肝提拉法与传统方法的不同。结果38例患者均顺利安置双绕肝带，双绕肝提拉切肝时断面无明显出血，断面管道系统显示清晰，肝后下腔静脉与肝脏之间拉开1～2cni的间隙，以减少肝后下腔静脉及肝静脉、肝短静脉的损伤。与对照组相比，使用双绕肝提拉法的患者术中出血量少（t=4．112，P〈0．05），术后肝功能恢复快（χ2=11．14，P〈0．05），且胆汁瘘发生率低（P〈0．05），术后3个月内肿瘤肝内扩散、腹腔种植少（χ2=4．239，P〈0．05），而两组患者的手术时间比较差异无统计学意义（t=0．007，P〉0．05）。结论采用改良后的方法建立肝后隧道成功率高。双绕肝提拉前入路半肝切除术具有减少术中出血量、减轻术后肝功能损害，降低胆汁瘘发生率及肿瘤肝内扩散和腹腔种植等特点。

Objective To improve the technique of constructing the liver hanging maneuver and evaluate the double liver hanging maneuver in hemihepatectomy. Methods The liver hanging maneuver was performed by biliary tract probes instead of forceps and two tapes were passed through the retrohepatic avascular space. Thirty eight patients underwent hemihepatectomy using double liver hanging maneuver, and related clinicopathological data were collected after operation. Eighty-nine patients undergoing hemihepatectomy previously using traditional methods for exposure and bleeding control were grouped into the control. Results Double liver hanging maneuver was performed successfully in 38 patients, there was no significant bleeding on the hepatic transecion plane, and the Glisson＇s components clearly exposed. There was about 1 cm wide space located between retrohepatic IVC and dorsal liver when the 2 tapes were pulled, and no injury of hepatic short veins and retrohepatic IVC occured during the operations ; Compared with the control group, blood loss was much less （t = 4. 112, P 〈 0.05 ） ; ALT and liver function alterations recovered faster postoperatively in liver hanging group （χ2 = 11.14, P 〈 0. 05 ） ; The rate of bile fistula was lower（ P 〈 0. 05 ） ; The rate of tumor metastasis in liver and abdominal cavity was much lower（χ2 = 4. 239, P 〈 0. 05 ） ; The difference of operative time between the two groups was not significant （ t = 0. 007, P 〉 0. 05 ）. Conclusion The liver hanging maneuver was easier to do by using biliary tract divining rod instead of forceps. Double liver hanging maneuver in hemihepatectomy helps to reduce blood loss, alleviate liver damage intraoperatively, decrease the rate of bile fistula and tumor metastasis.