半肝切除术三种肝血流阻断方法对手术预后的影响研究

Influence of three kinds of hepatic blood flow occlusion methods on operation prognosis of hemibepatectomy

目的探讨在半肝切除术中分别应用三种不同的肝血流阻断法,观察其应用效果及对术后患者预后的影响。方法选取自2010年11月至2011年11月在新桥医院住院需实施半肝切除术的患者共120例,将其作为临床研究对象,并依据随机数字原则分为A、B、C组,每组40例,A组患者采取Pringle法进行肝血流阻断,B组患者采取选择性出入肝血流阻断术,C组患者采取肝悬吊法联合选择性出入肝血流阻断术。观察并比较3组患者的疗效及预后情况。结果 3组患者的手术时间、肝血流阻断时间差异无统计学意义(P>0.05);A组患者术中出血量和平均输血量较B、C组多;A组患者的血清清蛋白含量明显低于B、C两组,而血清总胆红素和丙氨酸氨基转移酶较B、C两组高;A组患者并发症的发生率为37.50%,明显高于B、C组的发生率15.00%、12.50%;术后2年内,B、C两组患者的生存率分别为72.50%、75.00%,明显高于A组患者,A组患者的预后较差,差异有统计学意义(P<0.05)。B、C两组间比较无明显差异(P>0.05)。结论选择性出入肝血流阻断术在半肝切除术中不仅明显减少术中出血量和输血量,还降低术后并发症的发生率及肝功能的损害程度,且术后2年内的生存率较高,预后情况较好。

Objective To explore the application of three types of hepatic blood flow occlusion on operation prognosis of hemibepatectomy .Methods A total of 120 patients ,receiving hemibepatectomy during Jan .2010 and Jan .2011 ,were randomly divided into group A ,B and C ,40 cases for each ,receiving Pringle of hepatic blood flow oc-clusion ,selective hepatic outflow block ,and liver hanging maneuver combined with selective total hepatic blood occlu-sion respectively .Curative effect and prognosis were compared between each group .Results The operation time and hepatic blood flow occlusion time were not statistical different between the three groups （P〉0 .05） .Bleeding volume and average volume of blood transfusion of group A were higher than group B and C .Serum albumin content in group A was significantly lower than group B and C ,while serum levels of total bilirubin and alanine aminotransferase were higher .The incidence of complications was 37 .50% in group A ,significantly higher than the 15 .11% and 12 .50% of group B and C .Two years after operation ,the survival rates of group B and C were 72 .50% and 75 .00% ,higher than group A（P0 .05） .Conclusion Selective hepatic outflow occlusion in hemibepatectomy could not only significantly reduce bleeding and blood transfusion vol-ume during operation ,but also could reduce the incidence of postoperative complications and liver function damage , and the postoperative 2 years survival rate might be satisfactory and the prognosis could be fine .