改良式肝提拉法血流阻断无血肝切除的临床应用研究

Clinics studying of hemihepatectomy by retrohepatic tunnel of the IVC of improvements liver hanging maneuver

目的运用随机对照试验方法,对比研究第一肝门阻断、半肝入肝血流阻断和改良式绕肝提拉法肝血流阻断在肝切除中的临床运用价值,探讨改良绕肝提拉法(liver hanging maneuver)肝切除的临床实用性和安全性。方法将同期164例需行半肝切除的患者按入院时间随机分为第一肝门阻断组(A组,n=49),半肝入肝血流阻断组(B组,n=56)、改良式绕肝提拉法肝血流阻断组(C组,n=59)。比较各组间患者术中出血量,手术时间,术后肝功能的恢复,术后血浆管引流量、输血量,术后并发症以及住院时间。结果三组患者术中出血量以A组出血最多,C组出血最少,经比较C组和A、B组间差异有统计学意义(P<0.05);A、B、C三组并发症例数和输血例数以C组最少,A组最多,但差异无统计学意义(P>0.05);患者术后第3、7天,A组血清转氨酶明显高于B、C组,组间差异有统计学意义(P<0.05),C组肝功能恢复最快。结论改良式绕肝提拉法肝血流阻断肝切除和半肝血流阻断肝切除比第一肝门阻断肝切除更利于术后肝功能恢复,减少手术并发症。改良式绕肝提拉法肝血流阻断肝切除技术是一种安全、实用、术后恢复快的肝切除方法。

Objective To enhance the operation safety and clinics significance of lobectomy after occlusion of Pringle,hemihepatic vascular control and improvements liver hanging maneuver hemihepatic blood flow with randomized contrast analysis.Methods 164 patients underwent hemihepatectomy were divided into three groups： Pringle group（A group,n = 49）,hemihepatic vascular control group（B group,n = 56） and improvements Belghiti hemihepatic blood flow group（C group,n = 59）.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared in the three groups.Results In three groups of patients with bleeding in the operation,group A was most,group C was at least,group C compared with group A and B,the differences were statistically significant（P 0.05）;the number of cases of complication of blood transfusion,in group C was at least,group A at most,but the difference was not statistically significant（P 0.05）;patients after 3,7 days,group A serum transaminases was higher than that of group B,group C,the differences were statistically significant（P 0.05）,group C liver function recovered most quickly.Conclusion The improvements Belghiti hemihepatic blood flow is an effective and safe procedure,and is a feasible and safe method resulting in fewer complications,suitable for application.