保留半肝动脉血流的肝门阻断在肝细胞癌肝切除术中的应用

Use of hepatic portal occlusion without hemihepatic artery control in liver resection for hepatocelluar carcinoma

目的探讨保留半肝动脉血流的肝门阻断（半肝阻断）在肝细胞癌（肝癌）肝切除术中的应用价值。方法回顾性分析2007年1月至2013年1月在南方医科大学南方医院肝胆外科行肝切除术的422例肝癌患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据术中采用入肝血流阻断法不同将患者分为半肝阻断组（140例）和Pringle组（282例）。半肝阻断组男114例，女26例；平均年龄（45±12）岁；采用半肝阻断法，沿肝固有动脉向上解剖游离出健侧肝动脉支，其余肝蒂包括患侧肝动脉、全肝门静脉及胆管以阻断带阻断。Pringle组男230例，女52例；年龄（47±13）岁；采用Pringle阻断法。比较两组手术时间，阻断时间，术中出血量，术后5 d内血ALT、TB峰值和术后并发症发生情况。观察两组患者2007～2009年和2010～2013年两个时间段数量的变化。两组数据比较采用t检验，率的比较采用χ2检验。结果半肝阻断组患者术后5 d内血ALT、TB峰值分别为（179±53）U/L、（24±9）μmol/L，Pringle组相应为（291±126）U/L、（30±15）μmol/L，差异有统计学意义（t=-12.757，-5.777；P0.05）。2007～2009年半肝阻断组患者占24.2%（53/219），2010～2013年升至42.9%（87/203）；2007～2009年Pringle组患者占75.8%（166/219），2010～2013年降至57.1%（116/203），两组数量变化差异有统计学意义（χ2=16.540，P〈0.05）。结论与Pringle阻断法相比，采用保留半肝动脉血流的肝门阻断法患者肝癌肝切除术后肝损害较轻，其临床应用近年有增加趋势。

Objective To investigate the value of hepatic portal occlusion without hemihepatic artery control （hemihepatic occlusion） in liver resection for hepatocelluar carcinoma （HCC）.Methods Clinical data of 422 patients with HCC undergoing liver resection in Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University from January 2007 to January 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into two groups according to the different hepatic inlfow occlusions：the hemihepatic occlusion group （n=140） and Pringle maneuver group （n=282）. There were 114 males and 26 females in the hemihepatic occlusion group with a mean of （45±12） years old. Hemihepatic occlusion＆nbsp;was performed in this group and the hepatic arterial branch of the healthy side was dissected up along the proper hepatic artery. The other hepatic pedicles including hepatic artery of the diseased side, hepatic portal vein and bile duct were occluded with occluding straps. There were 230 males and 52 females in the Pringle maneuver group with a mean of （47±13） years old and Pringle maneuver was performed. The differences were compared between two groups in the operation time, occlusion time, intraoperative blood loss, peak levels of blood alanine aminotransferase （ALT）, total bilirubin （TB） within 5 days after operation and incidence of postoperative complications. The variation of patient quantity in the periods of 2007-2009 and 2010-2013 in two groups was observed. The data between two groups were compared byt test and the comparison of ratio was conducted by Chi-square test.ResultsThe peak levels of blood ALT, TB within 5 days after operation were （179±53） U/L, （24±9） μmol/L in hemihepatic occlusion group and were （291±126） U/L, （30±15） μmol/L in Pringle maneuver group accordingly, where signiifcant differences were observed （t=-12.757,-5.777;P0.05）. From the year 2007 to 2009, the patients undergoing hemihepatic occlusion accounted for 24.2% （53/219） and increased to 42.9% （87/203） during the year 2010-2013. From the year 2007 to 2009, the patients undergoing Pringle maneuver accounted for 75.8% （166/219） and decreased to 57.1% （116/203） during the year 2010-2013. Signiifcant difference was observed in the variation of patient quantity between two groups （χ2=16.540,P〈0.05）.ConclusionsCompared with the Pringle maneuver, the hepatic portal occlusion without hemihepatic artery control causes lighter liver damage after liver resection in patients with HCC and it has been gradually widely used in clinic in recent years.