入肝动脉血流选择性阻断技术在肝肿瘤切除中的应用

Selective hepatic artery blocking for hepatectomy of hepatocellular carcinoma

目的 探讨一种新的入肝动脉血流选择性阻断技术，以减少手术失血量、降低手术风险。方法选择肝右叶肝癌患者56例，其中实验组25例，对照组31例。2组患者均采取常规后入路法行肝肿瘤切除。实验组先选择性阻断右肝动脉血流，再游离肿瘤所在肝右叶，当游离完成后再结合门静脉阻断，行肝肿瘤切除。对照组不先行阻断肝动脉血流，其他手术步骤与实验组相同。结果实验组与对照组的年龄、性别、肿瘤直径、肝硬化、HBsAg、AFP、门静脉主干癌栓、肝门阻断时间、手术时间、切除范围均无明显差别。实验组较对照组术中出血量明显减少，（272±113）ml比（547±221）ml，两组比较差异有统计学意义（t=-5．6，P〈0．01）。实验组患者术后恢复顺利，住院时间较对照组缩短，差异有统计学意义（f=-2．12，P〈0．05）。结论选择性阻断右肝叶的入肝动脉血流技术安全、可靠，能有效减少手术失血量，降低手术风险，提高安全性。

Objective To evaluate selective blocking of hepatic artery for hepatectomy in order to reduce blood loss. Methods Patients with liver cancer in fight hepatic lobe were randomly divided into study group （ n = 25 ） and control group （ n = 31 ）. Conventional posterior approach for liver tumor resection was applied. In study group, right hepatic artery was first freed and inflow was temporarily blocked before the fight liver lobe was freed from its peripheral attachment. Then hepateetomy was performed under Pringle＇s manouver. Result in term of blood loss was compared with that in control group in which hepatectomy was performed under Pringle＇s. Results There were no significant differences between two groups in age, sex, tumor size, liver cirrhosis, HBsAg, AFP and tumor emboli in portal vein. Blood loss in study group was significantly less （272 ± 113） ml than that in control group （547 ±221 ） ml,the difference was statistically significant（ t = - 5.6 ,P 〈 0.01 ）. The length of hospital stay was significantly shorter than that in control group （ t = - 2. 12, P 〈 0. 05）. Conclusions Initial hepatic artery blochade before liver freeing during the process of bepatectomy significantly reduced intraoperative in blood loss liver cancer patients.