区域性肝血流阻断在肝癌切除术中的应用与近期效果

Application and effects of regional hepatopetal blood flow occlusion in resection of hepatocellular carcinoma

目的:探讨区域性肝血流阻断在肝癌切除术中的应用价值。方法:回顾性分析69例肝癌切除术患者的临床资料,其中行区域性肝血流阻断肝癌切除38例,全肝入肝血流阻断(Pringle法)肝癌切除31例,比较两组患者的手术时间、术中出血量、术中输血率、术后并发症发生率、谷草转氨酶(AST)、引流量、排气时间、术后住院时间和标本切缘满意率。结果:与Pringle法肝癌切除组比较,区域性肝血流阻断肝癌切除组患者术中出血量、术后引流量、术后AST水平及并发症发生率均明显降低(均P<0.05);标本切缘满意率显著提高(P<0.05)。而术中输血率、术后排气时间、术后住院时间比较,两组间差异无统计学差异(均P>0.05)。结论:用区域性肝血流阻断法行肝癌切除术,具有术中出血少,手术打击小,肿瘤切缘满意率高,术后渗出和并发症少等优点。

Objective： To investigate the applying value of regional hepatopetal blood flow occlusion in resection of hepatocellular carcinoma. Methods： We retrospectively reviewed the clinical data of 69 patients undergoing resection of hepatocellular carcinoma,38 patients of them received hepatic carcinectomy with regional hepatopetal blood flow occlusion,the other 31 patients received hepatic carcinectomy with total hepatic vascular exclusion（ Pringle method）.The operative time,intraoperative blood loss,rate of intraoperative blood transfusion,incidence of postoperative complications,postoperative aspartate transaminase（ AST） level,postoperative drainage volume,time to flatus,length of postoperative hospitalization and satisfactory rate of operation margin of the two groups were compared. Results： The intraoperative blood loss,postoperative drainage volume,AST level and incidence of postoperative complications were significantly reduced but the rate of satisfactory resection margin was significantly increased in regional hepatopetal blood flow occlusion group compared with Pringle method group（ all P〈0. 05）. No differences between the two groups were noted of the rate of intraoperative blood transfusion,time span for flatus,length of postoperative hospital stay（ all P〈0. 05）. Conclusion： Resection of hepatocellular carcinoma with regional hepatopetal blood flow occlusion has the advantages of less intraoperative blood loss,minimum surgical trauma,increased rate of satisfactory resection margin as well as reduced exudation and less complications.