肝癌肝切除术中血流控制方式选择和评价

Selection and evaluation of hepatic blood flow control in hepatectomy

目前,肝切除术仍是治疗肝癌的主要方法,在手术中,如何选择和运用合适的肝血流控制技术是影响肝脏手术结果的重要因素,同样也影响着术后并发症发生率及病死率。肝血流控制技术主要包括局部肝血流控制、入肝血流控制、出肝血流控制、全肝血流控制、低中心静脉压技术和肝脏悬吊术。安全成功的肝脏外科手术需要外科医师熟悉每种血流控制技术,然后再根据肿瘤位置、肝脏储备、心血管状况和术者经验选择合理的血流控制方式。

Hepatectomy is still the main method for treatment of hepatocellular carcinoma. How to select and apply hepatic blood flow control techniques in surgery is an important factor affecting the surgical result，which is also an important factor influencing the postoperative complications and disease mortality. Hepatic blood flow control techniques include regional blood blockage，hepatic vascular inflow control，hepatic blood flow control，total hepatic vascular control，low central venous pressure and liver hanging maneuver. Altogether，safe liver surgery requires knowledge of each regular technique of vascular control，which has its place in liver surgery，depending on tumor location，underlying liver disease，patient cardiovascular status，and the experience of the surgeon.