肝脏血流阻断方法及评价

Methods and evaluation of hepatic vascular occlusion

肝切除仍然是目前治疗肝肿瘤的主要方法。如何控制术中出血一直是影响手术成败的关键问题。术中出血以及输血是影响患者预后，增加术后并发症及病死率的重要因素。目前用于肝切除术中减少出血的方法主要有：切肝前结扎患侧肝脏血管；术中采用超声吸引刀、氩气刀等特殊器械行精准肝切除；术中降低中心静脉压；术中行肝脏血流阻断等。鉴于肝脏出血主要发生在肝切除的手术过程中，熟练掌握肝切除术中各种血流阻断方法，尽量减少或避免出血及输血，根据具体情况选择最佳的血流阻断方式则显得尤为重要。

Hepatectomy is the main option of treatment for liver cancer, and how to control the blood loss is an important issue for the recovery of patients. Continuous hepatic vascular occlusion （Pringle maneuver） is the oldest and simplest way for vascular occlusion and still used in clinical practice. But continuous hepatic vascular occlusion often gives rise to post- isehemic reperfusion injury due to clamping the portal vein and the hepatic artery in the hepatic pedicle. So intermittent clamping or hemihepatic vascular occlusion is recommended in complex liver resections or for patients with liver cirrhosis. Total hepatic vascular exclusion has the advantages of occlusion of vascular inflow and outflow of the liver, and is mainly used for patients with tumors invading the caval veins. Major hepatic veins and limited inferior vena cava reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins. It is crucial to know how to select the opti- mal methods of hepatic vascular occlusion according to the specific conditions. Focusing on this issue, we have reviewed and evaluated various methods and relevant researches in this paper.