前入路绕肝提拉法半肝切除在肝硬化患者中的应用

Hemihepatectomy using anterior approach with liver hanging maneuver in patients with liver cirrhosis

目的:探讨前入路绕肝提拉法半肝切除在肝硬化患者中应用的安全性及可行性。方法:2008年1月—2011年6月间笔者从拟行半肝切除的肝硬化患者中选择45例,随机分成前入路组和常规组。前入路组22例,使用前入路绕肝提拉法行半肝切除;常规组23例,使用常规法半肝切除。比较两组的手术时间、术中失血量、输血例数、住院时间、并发症等以及围手术期肝功能指标。结果:两组患者均成功施行手术治疗。前入路组行右半肝切除17例,左半肝切除5例,患者均成功建立肝后隧道;常规组行右半肝切除19例,左半肝切除4例。与常规组比较,前入路组术中出血量及输血例数少、手术时间短、并发症少、术后谷丙转氨酶(ALT)和谷草转氨酶(AST)恢复较快(均P<0.05),两组患者住院时间及术后总胆红素(TBIL)变化无明显差异(均P>0.05)。结论:在肝硬化患者中施行前入路绕肝提拉法半肝切除可减少术中出血,缩短手术时间,有利于肝功能恢复,临床应用是安全可行的。

To investigate the safety and feasibility of hemihepatectomy using anterior approach with liver hanging maneuver in patients with liver cirrhosis. Methods： From January 2008 to June 2011, 45 patients with liver cirrhosis scheduled for hemihepatectomy were selected and randomly designated either to using anterior approach with liver hanging maneuver （anterior approach group, 22 cases） or conventional approach （conventional group, 23 cases）. Comparisons were conducted between the two groups in respect to the operative time, intraoperative blood loss, number of blood transfusion required, length of hospital stay and complications as well as the perioperative liver function parameters. Results： Operations were successfully performed in all patients of the two groups. In anterior approach group, 17 cases underwent right hepatectomy, 5 cases underwent left hepatectomy and the retrohepatic tunnel in all of them was created successfully. In conventional group, 19 cases underwent right hepatectomy and 4 cases underwent left hepatectomy. Compared with conventional group, anterior approach group hadreduced intraoperative blood loss and number of blood transfusion required, shortened operative time, fewer postoperative complications, faster recovery of postoperative alanine aminotranferease （ALT） and aspartate aminotransferase （AST） levels （all P〈0.05）. No significant differences were seen in the length of hospital stay and change of postoperative total bilirubin （TBIL） level between the two groups （all P〉0.05）. Conclusion： Hemihepatectomy using anterior approach with liver hanging maneuver in patients with liver cirrhosis is safe and feasible, because it can reduce the intraoperative blood loss and operative time and accelerate liver function recovery.