半肝入肝血流加肝静脉阻断在规则性肝切除术中的应用

Occlusion of hemihepatic inflow plus ipsilateral major hepatic veins in anatomic hepatectomy

目的:探讨半肝入肝血流加肝静脉阻断术在规则性肝切除术中的意义。方法:行半肝入肝血流加肝静脉阻断术42例(A组)、半肝入肝血流阻断术30例(B组)、全肝入肝血流阻断术30例(C组),比较3组患者的手术时间、术中出血量以及术后第1、3、6天的血清谷丙转氨酶(ALT)、胆红素、白蛋白水平和术后并发症的发生率。结果:术中平均出血量分别为(453.5±87.9)、(612.8±101.6)和(646.7±136.6)mL,A组显著低于B组和C组(P<0.05),B组和C组间差异无统计学意义(P>0.05),3组患者的手术时间差异无统计学意义(P>0.05);A组和B组在术后第3、6天的血清ALT、胆红素水平显著低于C组,而血清白蛋白水平显著高于C组(P<0.001),A组和B组间差异无统计学意义(P>0.05);A组和B组的术后腹水发生率均显著低于C组(P<0.01)。结论:半肝入肝血流加肝静脉阻断术可显著减少肝切除术中的出血,减轻术中、术后肝功能的损害,是一种安全、有效的肝切除方法。

Objective： To evaluate the significance of occlusion of hemihepatic inflow plus major ipsilateral hepatic veins in anatomic hepatectomy. Methods： One hundred and two cases were divided into 3 groups for anatomic hepatectomy： Group A （hemihepatic inflow plus major hepatic vein occlusion, n=42）, Group B （hemihepatic inflow occlusion, n=30）and Group C （Pringle maneuver, n=30）. The amount of intraoperative bleeding, time of operation, postoperative liver function, liver function recovering and complications were compared. Results： The average amount of hemorrhage in Group A, Group B and Group C were（453.5±87.9）、（612.8±101.6）and（646.7±136.6）mL, respectively. The mean blood loss in Group A was significantly more than that in Group B and Group C （P0.05）. No differences were observed in time of operation among the 3 groups （P0.05）. The levels of serum alanine transaminase （ALT）and bilirubin of 3rd and 6th day of postoperation in Group A and Group B were significantly lower than that in Group C, while the level of serum albumin in Group A and Group B was significantly higher than that in Group C（P0.001）, no differences observed between Group A and Group B（P0.05）. Incidence of ascites in Group C was significantly higher than in Group A and Group B （P0.01）. Conclusions： For anatomic hepatectomy, occlusion of hemihepatic inflow plus ipsilateral major hepatic veins has the advantage of less blood loss and protecting contralateral hemiliver from intraoperative and postoperative reperfusion injuries. It is a new, safe and effective technique in hepatectomy.