单侧入肝血流联合肝静脉阻断在复杂肝切除中的应用

Application of combined hemihepatic infow and hepatic veins occlusion in major hepatectomy

目的探讨单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中的应用价值。方法回顾性分析46例巨块型肝癌通过预先解剖、控制患侧入肝血流联合阻断出肝血流行切肝术患者的临床资料。结果 46例患者均为原发性肝癌,肿瘤平均直径8.3 cm(6～15 cm),肿瘤侵犯1根主肝静脉20例,侵犯2根主肝静脉14例。行右半肝切除16例,右后叶肝切除14例,左半肝切除16例。平均患侧入肝血流阻断时间30 min(10～45 min),平均肝静脉阻断时间20 min(10～30 min)。行肝静脉修补5例。平均术中出血量540 mL(300～1 500 mL)。全组术后发生并发症14例次,均经治疗后痊愈,无死亡病例。结论单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中能明显减少术中出血,降低术后肝功能衰竭发生率,是一种安全、可行实用的血流阻断技术。

Objective To evaluate the effect of application of combined hemihepatic inflow and hepatic veins occlusion in major liver resection.Methods The clinical data of 46 cases of large hepatic carcinoma who underwent liver resection were surveyed retrospectively.The hepatic pedicle of affected side and hepatic veins were dissected and controlled initially,then hepatectomy was performed under the condition of vascular exclusion of the affected side of liver.Results All the 46 cases suffered from hepatocellular carcinoma.The average size of the tumors was 8.3 cm（6-15 cm） in diameter.One main hepatic vein was invaded by tumor in 20 cases and 2 main hepatic veins were invaded by tumor in 14 cases.Among the 46 hepatectomies,right hemihepatectomy was performed in 16,right posterior lobe hepatectomy in 14,and left hemihepatectomy in 16 cases.The mean occlusion time of the hemihepatic pedicle was 30 min（10-45 min）,and occlusion time of the hepatic veins was 20 min（10-30 min）.The average blood loss was 540 ml（300-1 500 mL）.Postoperative complications occurred in 14 cases,and all recovered after treatment.There was no mortality in this series.Conclusions Combined hemihepatic inflow and hepatic veins occlusion in major hepatectomy is a safe,effective and practical vascular exclusion method which can effectively reduce the blood loss and the incidence of the liver function failure.