选择性入肝血流阻断应用于肝癌合并门脉高压手术中的疗效观察

Clinical Observation of Selective Portal Vein Embolization in Surgery of Hepatic Carcinoma Combined with Portal Hypertension

目的：探究选择性入肝血流阻断（SPVE法）在肝癌合并门脉高压手术中的临床应用效果。方法：选择我院2009年10月～2014年10月期间确诊为肝癌合并门脉高压的患者80例,按照随机数字数表法分为观察组和对照组各40例,观察组行SPVE法进行血流阻断,对照组行全入肝血流阻断法（Pringle法）进行血流阻断。对比两组手术时间、阻断血流时间、手术中出血量、输血量、手术前后患者肝功能相关指标及术后并发症发生率。结果：两组手术时间和血流阻断时间对比差异无统计学意义（P〉0.05）,而观察组术中出血量及输血量均小于对照组,差异具有统计学意义（P〈0.05）;术后观察组血液中谷丙转氨酶（ALT）、谷草转氨酶（AST）和总胆红素（TB）水平均低于对照组,而血清蛋白（ALB）和血红蛋白（Hb）水平高于对照组,差异均有统计学意义（均P〈0.05）;观察组并发症发生率为22.5%,明显低于对照组的37.5%,差异有统计学意义（P〈0.05）。结论：SPVE法应用在肝癌合并门脉高压手术中,可以显著减少术中的出血量和输血量,有利于术后肝功能的恢复,有效地降低术后并发症的发生。

Objective： To investigate the clinical effect of selective portal vein embolization（SPVE method） in surgery of hepatic carcinoma combined with portal hypertension. Methods： 80 cases of patients with hepatic carcinoma combined with portal hypertension who were treated in our hospital from October 2009 to October 2014 were divided into observation group and control group, with 40 patients in each group, according to the random number table method. The blood flow in observation group was occluded by SPVE method, while control group was occluded by Pringle method.Compared the operation time, blood flow occlusion time, intraoperative blood loss and transfusion volume,liver function indexes before and after surgery and the incidence of postoperative complications of two groups. Results： There was no significant difference on the operation time and blood flow occlusion time between two groups（P〉0.05）,but the intraoperative blood loss and transfusion volume of observation group were less than control group, the differences were statistically significant（P〈0.05）; ALT, AST and TB levels in observation group were significantly lower than control group, but the ALB and Hb levels in observation group were significantly higher than control group after surgery, the differences were statistically significant（P〈0.05）; The incidence of postoperative complications in observation group was 22.5%, which was significantly lower than 37.5% in control group,the difference was statistically significant（P〈0.05）. Conclusion： SPVE method applied in surgery of hepatic carcinoma combined with portal hypertension has a good clinical effect,with the advantages of reducing intraoperative blood loss and transfusion volume, improving postoperative recovery of liver function and the incidence of complications.