不同肝血流阻断术在肝癌切除术中的应用

Clinical application of three methods of hepatic blood flow occlusion in hepatectomy for hepatocellular carcinoma

目的探讨不同肝血流阻断术在肝癌切除术中的临床应用。方法因原发性肝癌行半肝切除的肝癌患者117例,根据肝血流阻断方式分为三组:第一肝门血流阻断(Pringle's)组(62例)、半肝血流阻断(HHV)组(30例)和门静脉主干阻断(MPV)组(25例),比较三组手术及术后恢复情况。结果 117例患者均成功完成肝癌切除术。与Pringle's组比较,HHV组的阻断前手术时长和手术总时长延长(P<0.05),HHV组和MPV组患者住院总时间更短,肛门排气更早,并发症发生率更低(P<0.05)。术后第1、3天,HHV组和MPV组ALT和TBil低于Pringle's组(P<0.05);术后第7天,HHV组和MPV组ALT较Pringle's组低(P<0.05)。结论与Pringle's法相比,HHV和MPV具有并发症少、术后恢复快等优势,且MPV简便易行,不延长手术时间。

Objective To investigate the clinical application of three methods of hepatic blood flow occlusion in hepatectomy for hepatocellular carcinoma.Methods A total of 117 hepatocellular carcinoma patients undergoing hepatectomy was divided into three groups.The first hilar blood flow was blocked in group A（62 cases）,hemihepatic blood flow was occlusived in group B（30 cases）and portal vein was blocked in group C（25 cases）.The condition of surgery and postoperative recovery were compared.Results The surgeries were performed successfully in all patients.Compared to group A,the operation time before occlusion and total operation time were longer in group B,hospital stay was shorter,time of anus gas passage was earlier and incidence of complication was lower in groups of B and C（P〈0.05）.The ALT level was lower on the 1 st,3 rd and 7 th day and TBil was lower on the 1 st and 3 rd day in groups of B and C than those in group A（P〈0.05）.Conclusion Compared to first hilar blood flow occlusion,hemihepatic blood flow occlusion and portal vein occlusion have the advantages of less complications and quicker postoperative recovery,and portal vein occlusion is more convenient and does not prolong the operation time.