选择性保留半肝动脉血供的肝血流阻断法在肝癌肝切除术中的应用
Application of selective hemihepatic vascular exclusion in hepatectomy of hepatocellular carcinoma
郑瑞国 1窦科峰 2李军 2李海民2
作者信息
- 1. 第四军医大学西京医院肝胆外科,陕西,西安,710033;第二炮兵第535医院,湖南,怀化,418008
- 2. 第四军医大学西京医院肝胆外科,陕西,西安,710033
- 折叠
摘要
目的:探讨选择性保留半肝动脉血供的肝血流阻断法在肝癌肝切除术中应用的效果.方法:92例患者行三种不同肝血流阻断方法肝癌肝切除术,其中45例行Pringle肝血流阻断(A组),30例行半肝血流阻断(B组),17例行选择性保留半肝动脉血供的肝血流阻断(C组),观察手术情况及术后肝功能变化和并发症等情况并进行分析.结果:92例患者无手术死亡,A,B,C 3组在术中出血量、阻断时间、术后肠道功能恢复时间、术后腹腔感染、胆漏、消化道出血及顽固性腹水上比较无统计学差异;B组较A,C组手术时间延长,有显著差异(P<0.05),A,C组组间无统计学差异;A组较B,C组术后肝功能损伤严重,有显著差异(P<0.05),B,C组组间无统计学差异.结论:选择性保留半肝动脉血供的肝血流阻断法优于Pringle阻断法和半肝阻断法,为肝癌肝切除术中肝血流阻断提供一种既简便又实用的方法.
Abstract
AIM: To investigate the effect of selective hemihepatic vascular exclusion in hepatectomy of hepatocellular carcinoma. METHODS: Ninety-two patients underwent hepetectomy with 3 different hepatic vascular exclusion : 45 patients received hepatectomy with Pringle maneuver (group A ), 30 patients received hepatectomy with hemihepatic vascular exclusion (group B) and 17 patients received hepatectomy with selective hemihepatic vascular exclusion ( group C). Relative surgical parameters, the changes of postoperative liver function, recovery of intestine function and postoperative complications were evaluated and compared. RESULTS: There was no operative mortality. No significant difference was found in intraoperative blood loss, occlusion time, recovery of intestine function, abdominal infections after operation, bile leakage, alimentary tract hemorrhage and refractory ascites among the three groups. The operative time in group B was longer than that in group A and group C ( P < 0.05 ), but no statistically significant difference was seen between group A and group C. The damage of postoperative liver function in group A was worse than that in group B and group C ( P < 0.05 ) but no statistically significant difference was observed between group B and group C. CONCLUSION: Hepatectomy of selective hemihepatic vascular exclusion is better than hepatectomy with Pringle maneuver or hepatectomy with hemihepatic vascular exclusion. Hepatectomy of selective hemihepatic vascular exclusion is an easy and practical method for hepatectomy.
关键词
癌,肝细胞/肝切除术/肝血流阻断/Pringle法/半肝血流阻断法/选择性保留半肝动脉血供的肝血流阻断Key words
carcinoma, hepatocellular/hepatectomy/hepatic vascular occlusion/pringle maneuver/hemihepatic vascular occlusion/selective hemihepatic vascular occlusion引用本文复制引用
出版年
2009
NETL
NSTL
维普
万方数据