肝脏巨大血管瘤行肝静脉与下腔静脉阻断的临床效果分析

Blockade of the hepatic vein and inferior vena cava in treating huge hepatic hemangioma

目的探讨肝静脉肝外阻断在近第二肝门肝脏巨大血管瘤治疗中的应用。方法回顾性分析2012年2月至2014年5月收治的32例肝门肝脏巨大血管瘤患者的临床资料,根据治疗方法分为肝静脉阻断(HVE组14例)与下腔静脉阻断(IVE组18例)。记录两组患者术中情况、术后情况及并发症情况差异。在SPSS 10.0中进行统计分析,术中指标;术后第1、3、7天的生化指标以(x珋±s)表示,采用两样本独立t检验,两组间并发症率比较采用卡方检验,检验水准取α=0.05。结果 HVE组的手术时间、术中出血量、输血量、术后引流量均显著的低于IVE组(t=3.005、t=8.187、t=17.411、t=6.958,P<0.05)。IVE组的总胆红素(TBIL)在术后3 d显著高于HVE组(t=3.024,P=0.012);IVE组的ALT、AST在术后第1天显著高于HVE组(t=2.673、t=2.801、P<0.05)差异均有统计学意义。术后并发症HVE组为2例(14.29%)显著低于IVE组的9例(50.00%)(χ2=4.453,P=0.035)。结论相对于IVE技术,HVE技术的术中创伤更小,术后肝功能恢复更快,并发症发生率更低。

Objective To investigate the application of extrahepatic blockade of the second porta hepatis in treating huge liver hemangioma. Methods We retrospectively analyzed the clinical data of 32 patients with huge liver hemangioma treated from February 2012 to May 2014 . The 32 patients were divided into a hepatic vein blockade group （ HVE, 14 patients ） and an inferior vena cava blockade group （ IVE group,18 patients）. Both intraoperative and postoperative complications of the two groups were recorded. Statistical analysis was performed using SPSS10.0 software. Intraoperative index and biochemical indicator at postoperative day 1, 3 and 7 were represented as mean ：t： SD and were examined using independent samples t test. Postoperative complication rates were compared using the Chi-square test and inspection standards of a = 0. 05. Results Operation time, intraoperative blood loss, blood transfusion and postoperative drainage in the HVE group were significantly less than those in the IVE group （t = 3. 005, t = 8. 187, t = 17.411, t = 6. 958 respectively, P 〈 0.05 ）. TBIL at postoperative day 3 in the IVE group was significantly higher than that in the HVE group （t =3. 024, P =0. 012）. Aft and AST in the IVE group at postoperative day 1 were significantly higher than those in the HVE group （ t = 2. 673, t = 2. 801, P 〈 0.05 ）. There were 2 （ 14.29% ） patients with postoperative complications in the HVE group, in contrast to 9 （50.00%） patients in the IVE group （X2 = 4. 453, P = 0. 035 ）. Conclusions The intraoperative trauma caused by the HVE procedure is less frequent than that caused by the IVE procedure. HVE has a fast recovery of liver function and a lower complication rate.