选择性入肝血流阻断方法在肝癌合并门脉高压外科手术中的应用研究

Application research of selective hepatic blood flow occlusion in surgery of hepatic carcinoma combined with portal hypertension

目的分析选择性入肝血流阻断方法在肝癌合并门脉高压外科手术中的应用效果。方法选择乐清市人民医院及温州医科大学附属第一医院2011年7月-2013年7月收治的肝癌合并门脉高压患者80例，分为观察组和对照组，每组各40例。观察组患者采用选择性人肝血流阻断法进行血流阻断，对照组患者行全人肝血流阻法进行血流阻断。分别观察并统计两组患者的手术时间、血流阻断时间、术中出血量及术中输血量；对两组患者手术治疗前后的肝功能相关生化指标水平进行检测并统计；并观察、统计两组患者术后并发症的发生率。结果①两组手术时间、血流阻断时间比较，差异无统计学意义（P〉0．05）；观察组术中出血量[（267．43±121．23）mL]及术中输血量[（1．2±0．6）U]少于对照组[（445．23±145．56）mL、（2．2±0-8）u]，差异均有统计学意义（P〈0．05）。②两组术前谷丙转氨酶（ALT）、谷草转氨酶（AST）、血清蛋白（ALB）、总胆红素（TBIL）、直接胆红素（DBIL）、血红蛋白（Hb）和血小板（PLT）等指标比较，差异无统计学意义（P〉0．05）；术后观察组ALT[（42.33±7．44）mmol／L]、AST[（48．56±11．42）mmol／L]、TBIL[（108．23±43．25）μmol／L]、DBIL[（42．34±14．23）]xmol／L]、PET[（134．33±45．34）×10^9／L]等指标水平低于对照组[（73．23±14．26）mmol／L、（88．34±13．27）mmol／L、（182．35±81．28）μmol／L、（88．34±21．34）μmol／L、（201．24±36．34）×10^9／L]，ALB、Hb指标水平高于对照组，差异有统计学意义（P〈0．05）。③两组并发症总发生率比较，差异无统计学意义（P〉0．05）。结论在肝癌合并门脉高压外科手术中，选择性入肝血流阻断方法能有效减少患者术中出血量和输血量，减轻肝功能损害，且术后并发症少，值得临床推广与应用。

Objective To analyze the application effect selective hepatic blood flow occlusion in surgery of hepatic carcinoma combined with portal hypertension. Methods 80 cases of hepatic carcinoma combined with portal hypertension from July 2011 to July 2013 in People＇s Hospital of Yueqing City and the First Affiliated Hospital of Wenzhou Medical University were selected and divided into observation group and control group with 40 cases in each group. Observation group was treated by selective hepatic blood flow occlusion to block blood flow, the control group patients were treated by full hepatic blood flow occlusion method to block blood flow. Operation time, blood flow occlusion time, intraoperative blood loss, intraoperative blood transfusion volume between the two groups were observed. Related biochemical indicators of liver function before and after the operation was detected. The incidence of complications were between the two groups were observed. Results ①The differences of operation time, blood flow occlusion time between the two groups was not statistically significant （P 〉 0.05）; intraoperative blood loss and intraoperative blood transfusion volume in observation group [（267.43±121.23） mL, （1.2±0.6） U] were lower than those in control group [（445.23±145.56） mL, （2.2±0.8） U], the differences were statistically significant （P 〈 0.05）. （±）The differences of ALT, AST, ALB, TBIL, DBIL, Hb, PLT before the operation between the two groups were not statistically significant （P 〉 0.05）; the level of ALT, AST, TBIL, DBIL, PLT in observation group [（42.33±7.44） mmol/L, （48.56±11.42） mmol/L, （108.23±43.25） μmol/L, （42.34±14.23） μ mol/L, （134.33±45.34）×10^9/L] after the operation were lower than those in control group [（73.23±14.26） retool/L, （88.34±13.27） retool/L, （182.35±81.28） μ mol/L, （88.34±21.34） μmol/L, （201.24±36.34）×10^9/L], ALB, Hb observation group after the operation were higher than those in control group, the differences were all statistically significant （P 〈 0.05）. ③The difference of the total incidence of complications between the two groups were not statistically significant （P 〉 0.05）. Conclusion Selective hepatic blood flow occlusion method in the treatment of patients of hepatic carcinoma combined with portal hypertension can effectively decrease perioperative blood loss and blood transfusion, liver damage, and has less postoperative complications, it is worthy of clinical popularization and application.