不同入肝血流阻断在原发性肝癌切除术中的应用

The Application of Different Methods of Inflow Vascular Occlusion Technique During Hepatectomy of Liver Cancer

目的:比较分析不同入肝血流阻断方案在治疗原发性肝癌的效果。方法:选取本院肝胆外科2007年4月-2013年12月所收治肝癌切除病例58例,随机分为第一肝门阻断组(Pringle法)(A组22例)、半肝血流阻断组(B组19例)和保留半肝动脉血流阻断组(C组17例),分别比较三组患者的手术时间、术中出血量、术后住院时间、血清谷丙转氨酶(ALT)、总胆红素(TBIL)等肝功指标的水平以及安全性。结果:手术时间上B组较C组和A组明显延长,差异均有统计学意义(P<0.05);C组和A组比较差异无统计学意义(P>0.05)。术后肝功能及恢复情况B组、C组与A组比较差异均有统计学意义(P>0.05)。结论:三种不同的入肝血流阻断均能有效地控制出血,半肝血流阻断和保留半肝动脉血流阻断更安全,安全性高;同半肝血流阻断相比,保留半肝动脉血流阻断具有操作相对简单、安全省时的优点。

Objective： To comparative analysis of different hepatic inflow occlusion effect regimen in the treatment of primary liver cancer.Method：58 cases were selected from April 2007 to December 2013 at the department of hepatobiliary surgery in our hospital,who were treated by resection of hepatocellular carcinoma,and randomly divided into the first hepatic portal occlusion group（Pringle） as the group A of 22 cases,hemihepatic vascular occlusion group as the group B of 19 cases and selective hemihepatic vascular occlusion group as the group C of 17 cases.The three groups of patients were compared with operation time, intraoperative bleeding and postoperative hospitalization time, serum alanine aminotransferase（ALT）,total bilirubin（TBIL） and other liver index level and safety.Result：The operation time of B group was respectively longer than that of C group and A group,the differences were statistically significant（P〈0.05）, no significant differences between group C and group A.The B group and C group compared with A group of postoperative liver function and recovery, the difference were statistically significant（P〈0.05）.Conclusion：Three kinds of different hepatic inflow occlusion can effectively control the bleeding, hemihepatic blood flow occlusion group and selective hemihepatic vascular occlusion group more security, the security is high; compared with hemihepatic, selective hemihepatic vascular occlusion group has the advantages of safe operation relatively simple and time-saving.