选择性出入肝血流阻断用于肝脏巨大血管瘤的切除

Selective exclusion of hepatic outflow and inflow for giant hepatic hemangioma resection

目的探讨右肝静脉阻断技术在累及第二肝门巨大肝血管瘤切除术中防止右肝静脉破裂大出血、空气栓塞的作用。方法回顾分析2004年1月至2010年3月浙江省人民医院肝胆外科对12例累及第二肝门巨大肝血管瘤患者施行右肝静脉阻断技术行巨大肝血管瘤切除的临床资料。右肝静脉阻断方法采用血管带阻断或血管夹夹闭。无肝硬化患者同时采用第一肝门阻断（Pringle），或选择性入肝血流阻断；有肝硬化患者采用半肝入肝血流阻断。结果12例患者中无1例分破肝静脉。右肝静脉血管阻断方法：血管夹夹闭法3例，血管带阻断法9例。11例无肝硬化患者行第一肝门阻断5例，6例行选择性人肝血流阻断，1例患者由于肝炎后肝硬化施行交替半肝血流阻断。12例患者血管瘤切除顺利，出血量200～5800ml，平均出血量680ml，其中3例患者未输血。出血量最大1例为肝动脉栓塞治疗2次的患者，血管瘤与隔肌粘连紧密，侧支循环丰富，解剖困难。无1例因肝静脉破裂而出血或发生空气栓塞。结论切除累及第二肝门巨大肝血管瘤时施行右肝静脉阻断技术是安全，有效的。

Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People＇s Hospital from 2004.1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp. Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.