选择性入肝血流阻断应用于腹腔镜肝切除术的临床策略

Clinical strategy of selective hepatic entry blood flow occlusion in laparoscopic hepatectomy

目的探讨选择性入肝血流阻断技术在腹腔镜肝切除术中的应用价值。方法2019年8月至2020年9月,对70例肝脏病变患者施行腹腔镜肝切除术,术中根据肿瘤大小、位置及其他病变特点采用不同的选择性入肝血流阻断技术。结果70例患者均采用不同的选择性入肝血流阻断技术顺利完成腹腔镜肝切除手术无中转开腹病例,手术时间75~320 min,平均(226.0±64.1)min,术中出血量20~800 mL,平均(203.9±193.2)mL,术后住院时间6~18 d,平均(11.8±2.9)术后发生胆瘘3例、胸腔积液1例,并发症发生率为5.7%,无大出血或肝衰竭等并发症,无围手术期死亡病例。结论选择性入肝血流阻断技术是安全可行的,应根据肿瘤大小和位置选择合适的血流阻断方式。综合考虑后选择最佳阻断方式,才能有效地减少术中出血,降低肝脏缺血再灌注损伤,减少术中及术后并发症。

Objective To investigate the clinical value of selective hepatic flow occlusion technology for laparoscopic liver resection.Methods From August 2019 to September 2020,laparoscopic hepatec⁃tomy was performed in 70 patients with liver diseases.Different selective hepatic flow occlusion tech⁃niques were used during the operation according to tumor size,location and other characteristics of the lesions.Results All the 70 patients successfully were completed laparoscopic hepatectomy by different selective entryhepatic blood flow occlusion techniques,without conversion to open surgery.The operation time was 75⁃320 min,with an average of(226.0±64.1)min,and the intraoperative blood loss was(20⁃800)ml,with an average of(203.9±193.2)ml.The postoperative hospitalization time was 6⁃18 d.The average postoperative biliary fistula occurred in 3 cases and pleural effusion in 1 case(11.8±2.9),with a complication rate of 5.7%.There were no complications such as massive hemorrhage or liver failure,and no perioperative death.Conclusion Laparoscopic liver resection with elective hepatic flow occlusion technology is safe and feasible in clinical application.After comprehensive consideration,the optimal hepatic flow occlusion techniques can effectively reduce intraoperative bleeding,liver ischemia reperfusion in⁃jury,and intraoperative and postoperative complications.