肝脏血流阻断在肝脏部分切除手术中应用的动物研究

Application of hepatic blood flow block in the liver excision surgery

目的分析并评价血流阻断在家兔肝脏部分切除手术中的应用。方法取家兔为实验对象,分为四组,每组20只,分别对其进行Pringle法、半肝阻断法、半肝阻断+肝下下腔静脉阻断法阻断肝脏血流及空白对照(仅开腹,但不做其他处理),分别测量阻断前、后的中心静脉压,肝脏部分切除后的出血量(切除相同部位的肝脏,尽量保证其大小及肝脏断面的面积相等),阻断20 min后恢复肝脏血流30 min,分别测量阻断前后转氨酶的数值。对所取得的数据进行统计学分析。为了解肝下下腔静脉阻断对家兔的影响,另取家兔15只,全麻后开腹结扎其肝下下腔静脉(肾静脉以上),关腹后清醒麻醉,观察其存活情况及术后第7天的肝、肾功能变化。结果 1除半肝阻断法外,其余方法中心静脉压显著下降。2三种阻断方法的出血量均较对照组减少,半肝阻断+肝下下腔静脉阻断法出血量最少。3三种阻断方法均对肝功能有损害,Pringle法损害最大,其余两种方法无明显差异。单纯结扎肝下下腔静脉对家兔无明显影响(麻醉清醒后可正常进食及活动),术前、术后的肝、肾功能变化差异无统计学意义。结论肝下下腔静脉联合半肝血流阻断在肝脏部分切除手术中可有效降低中心静脉压,减轻术中出血,同时不增加肝功能损害,是一种安全、有效的阻断方法。

Objective To study the application of hepatic blood flow block in the liver excision surgery in rabbits.Methods Eighty rabbits were randomly assigned into 4 groups,receiving Pringle maneuver,hemihepatic vascular occlusion,hemihepatic vascular occlusion combined with infrahepatic IVC clamping,and a blank control（ processing laparotomy only）. In all cases,three parameters were measured： 1CVP prior to and after vascular occlusion; 2Blood loss after hepatectomy,where same part and same size of the liver were resected; 3Liver function before blood flow exclusion for 20 minutes,and after 30 minutes of reperfusion. Fifteen extra rabbits were operated to evaluate the effects of infrahepatic IVC clamping on liver and renal function. Infrahepatic and suprarenal IVC was ligated in laparotomy with general aneasthesia. Post-operative vital signs,liver and renal function were recorded for 7 days. Results 1CVP decreased significantly except in the hemihepatic vascular occlusion.2Blood loss during operation in three experiment groups were all less than the control group,the hemihepatic vascular occlusion combined with infrahepatic IVC clamping group was less than the others. 3Liver function was impaired in all three experiment groups. There was no significant difference was found between the second and third group,which were both better than the Pringle maneuver group. At last,single ligation of infrahepatic IVC did not had any impact on rabbits. Conclusion Hemihepatic vascular occlusion combined with infrahepatic IVC clamping can effectively reduce the central venous pressure,and intraoperative hemorrhage in the liver excision surgery,without increase of the damage of liver function,is a safe and effective method for blocking blood flow.