肝血流阻断方法在肝硬化患者肝肿瘤手术中的选择

Application of different hepatic blood occlusion for hepatic resection in cirrhotic patients

目的:评价肝硬化患者行肝脏肿瘤切除术时肝血流阻断方法的选用。方法:将我院2007年6月—2012年12月63例需行肝切除的肝肿瘤伴肝硬化患者随机分为3组。A组22例,为间歇血流阻断组,采用阻断肝血流15 min,复流5 min;B组20例,为半肝血流阻断组,行同侧半肝血流持续性阻断,健侧血流正常;IP组21例,采用入肝血流阻断前先阻断5 min、复流5 min的预处理方法。比较3组术中阻断时间、肝断面单位面积出血量、3组及3组中阻断时间<30 min者术后1、3、7、14 d的ALT、AST及TB变化情况。结果:3组肝断面单位面积出血量差异有统计学意义(P<0.05)。术后B组缺血再灌注损伤最轻,IP组最重,差异有统计学意义(P<0.05)。阻断时间<30min者术后肝功比较,IP组较A组缺血再灌注损伤明显降低(P<0.05)。结论:肝血流阻断前预处理可减少肝切除术中的失血量。术前预计切除时间<30 min的患者可采用预处理减少出血量及再灌注损伤。

Objective： To evaluate the optimal method of hepatic blood occlusion for resection of hepatoma with cirrhosis. Methods： 63 unselected patients undergoing hepatectomy from June 2007 to December 2012 were divided into three groups. Group A （n=22）： intermittent blood occlu-sion, patients of group A were performed with 15 minutes of occlusion and 5 minutes releasing. Group B（n=20）： hemihepatic inflow occlusion. Patients with optional half-hepatic blood occlusion to preclude the ipsilateral hepatic blood while kept the contralateral hepatic blood. IP group （n=21） with 5 minutes of ischemia followed by 5 minutes reperfusion before hepatic blood occlusion. Comparing three group＇ s total blocking time, Blood losses of per unit area of liver section, comparing postoperative 1, 3, 7, 14 days of ALT, AST and TB changes on patients in three groups and patients in each group＇s total block- ing time 〈 30 minutes. Results： Significant difference were found in three groups on blood loss of per unit area of liver section. Three groups had statistical significance（P〈0.05 or P〈0.01）. Comparing post- operative hepatic function in groups, Ischemia-reperfusion injury was the lowest in group B, highest in IP group, and three groups had1 statistical significance （P〈0.05 or P〈0.01）. Comparing postoperative hepatic function on patients＇ blood blocking time 〈30 minutes in three groups. Ischemia-reperfusion injury in iP group was much lower compared to group A and have statistical significance with group A （P〈0.05）. Conclusion： Hepatic ischemia preconditioning can reduce blood loss Significantly during hepa- tectomy with cirrhosis. Ischemic preconditioning can be chosen before occlusion to reduce blood loss and ischemia-reperfusion injury if the surgery expected time less than 30 minutes.