永久阻断肝静脉对肝创面出血量和肝功能的影响

LIVER FUNCTION AND SURFACE BLEEDING OF THE WOUND AFFECTED BY LIGATION OF HEPATIC VEIN

目的 了解永久阻断肝静脉后对肝脏手术患者出血量和肝功能的影响。方法 回顾性统计分析 2 9例在结扎右肝静脉情况下行肝右后叶肝脏肿瘤切除术 (结扎组 )和 9例缝扎肝静脉 (左 4、中 3、右 2 ) (缝扎组 )控制近第二肝门肝损伤大出血后患者腹腔出血量和肝功能的变化 ,并与同期同部位未行肝静脉结扎的 36例肝脏肿瘤切除术患者和 15例按其它方法处理的合并肝静脉损伤的近第二肝门肝损伤患者进行对照。结果 结扎组、缝扎组患者术后立即出现转氨酶增高 ,但无明显黄疸 ,术后 1周肝功能均全部恢复正常 ;无严重手术并发症发生 ,无手术死亡 ,一期愈合率 10 0 %。对照组 2例死于术后肝功能衰竭 ;1例因出血不止死亡 ;2例因术后再出血、膈下脓肿行二次手术。结扎组术中出血量是 42 8± 2 5 3ml,对照组是 789± 2 71ml;缝扎组术后出血量为 2 6 2± 10 2 ml,对照组为 831± 387m l,P<0 .0 1。结论 永久结扎阻断一支肝静脉能明显减少肝脏手术特别是合并肝静脉损伤创面的出血量 。

Objective To observe liver function and surface bleeding of the wound changed by the ligation with hepatic vein through clinical analyses.Methods 29 cases with hepatic tumors in retroright lobe resected under the condition of ligation of right hepatic vein and 9 cases of hepatic vein injuries sutured to reduce the bleeding were analyzed retrospectively.Their intraoperative and post operative blood loss in ligation group,in suture group and their hepatic function were observed and compared to control group.Results The ALT level were temporarily increased and bile level were normal steadily.All patients in observation group were recovered in 10 to 20 days,and there was no serious complication observed.Critical complications were occurred in control group and 3 patients died of hepatic dysfunction and uncontrolled bleeding.The introoperative blood loss in ligation group and postoperative one in suture group were 428±253ml and 262±102ml,obviously lower than that in control group (789±271ml and 831±387ml,P<0.01).Conclusion Ligation or suture of one main hepatic vein could reduce surface's blood loss of the hepatic wound and there was no obvious affection on the recovery of hepatic function.