肠钳夹压法区域性肝血流阻断在肝切除术中的应用

Regional hepatic vascular exclusion with intestinal forceps clamping maneuver in hepatectomy

目的总结肠钳夹压法区域性肝血流阻断行肝切除的经验。方法回顾分析26例肠钳夹压法区域性肝血流阻断行肝切除的临床疗效。包括:外侧左肝外侧叶切除15例、肝段或不规则肝段切除11例。记录肝血流阻断时间及出血量。结果本组病例无死亡。所有病例均一次性阻断肝脏血流,左肝外侧叶切除(即肝血流阻断时间)平均手术时间(16.37±2.01)min,术中出血量平均(250.40±20.04)ml;肝段或部分肝切除平均手术时间(18.20±8.03)min,术中出血量平均(190.30±40.02)ml。术中输血3例。术后并发胆瘘1例、切口感染2例。结论肠钳夹压法区域性肝血流阻断下进行肝切除能完全阻断病灶肝的全部入肝出肝血流,术中出血量较少,是一种简便、安全且有效的方法。

Objective To evaluate the effect of regional hepatic vascular exclusion with intestinal forceps clamping maneuver in hepatectomy. Methods Clinical data of 26 patients underwent hepatectomy with regional hepatic vascular exclusion with intestinal forceps clamping maneuver were analyzed. Operation methods included left lateral lobectomy in 15 patients and regular or irregular segmentectomy in 11 patients. The time of regional hepatic vascular exclusion and blood loss were recorded. Results There was no operative mortality. The average operative time of left lateral lobectomy was （16.37±2.01）min, and the average blood loss was （250.40±20.04）ml. The average operative time of regular or irregular segmentectomy was （18.20±8.03）min, and the average blood loss was （190.30±40.02）ml. Three patients needed operative blood transfusion. The major complications were bile leakage in 1 cases and wound infection in 2 cases. Conclusions Regional hepatic vascular exclusion with intestinal forceps clamping maneuver is not only a safe and feasible method, but also could prevent massive bleeding in liver resection.