肝切除过程中入肝血流阻断方法的探讨

Investigation on hepatic inflow occlusion method during hepatectomy

目的对肝切除过程中实施肝门血流阻断方法进行深入探讨。方法通过检索中国医院知识仓库全文数据库、MEDLINE相关文献对肝门血流阻断的方法进行分类,并客观评估每种方法的利弊。结果 Pringle法是最早应用于肝切术手术时控制肝断面失血量的方法,此法简单、易行,也是目前临床应用最广泛的一种方法,但是时间不宜过长,否则会对肝脏产生严重的缺血再灌注损伤,尤其对肝脏本身存在基础病变的患者;全肝血流阻断有很好的手术中控制失血量的效果,但是缺血再灌注损伤应引起重视;半肝血流阻断和保留肝动脉的半肝血流阻断方法一定程度上减轻了肝脏缺血再灌注损伤,但是只能应用于手术操作位于一侧半肝的患者,应用范围受到一定局限;肝段血流阻断法对肿瘤较小且局限于一个肝段或相邻几个肝段的手术操作是一种理想的阻断方法,但是由于操作复杂,定位困难,只能在一些医疗条件较好,且具备熟练解剖知识的高年资外科医生中开展。结论实施肝门血流阻断,控制肝断面失血量是肝脏手术中的一项重要技术,目前临床应用的肝门控制方法各有利弊,探索一种既有较好的止血效果,又最大限度的减少因阻断对肝脏产生损伤和对全身血流动力学影响的入肝血流阻断方法,仍然需要深入的研究和探讨。

Objective Deeply investigate hepatic blood flow occlusion methods used during hepatectomy.Methods Classify hepatic blood flow occlusion methods by retrieving Full-text database of China Hospital Knowledge Database and MEDLINE-related literatures and objectively assess advantages and disadvantages of each method.Results Pringle method was the first method controlling blood loss of liver sections used in hepatectomy.This method was simple and easy.Also,it is currently the most-wide clinical application method.However,the time can＇t be too long,or it will cause serious ischemia-reperfusion injury to liver,especially for patients with inherent basis liver lesion.Total hepatic blood flow occlusion has good effect on blood loss control during hepatectomy,but ischemia-reperfusion injury should be taken seriously;blood flow occlusion of half liver and half hepatic blood flow occlusion retaining hepatic artery reduce ischemia-reperfusion injury to liver to certain extent,but they can only be used for patients that surgical operation is carried out at the half liver on one side.The application range is subject to certain limitations.Blood flow occlusion method of hepatic segment is a good occlusion method for surgical operation that tumor is smaller and confined to one hepatic segment or adjacent hepatic segments.But as complex operation and difficult positioning,it only can be carried out by surgeons with good anatomical knowledge and many-year qualification in some hospitals with better medical conditions.Conclusion It is an important technology in hepatectomy to carry out hepatic blood flow occlusion and control blood loss of liver sections.Currently,clinically-used control methods have various advantages and disadvantages.It is required to further research and investigate for exploring one hepatic blood flow occlusion method that has better hemostatic effect and can minimize the damage of occlusion to liver and influence of occlusion on systemic hemodynamics.