不阻断入肝血流肝段切除术对肝癌患者肝功能的影响

目的 探讨不阻断入肝血流行肝段切除术的安全性及技巧,以及对残肝功能和术后并发症的影响.方法 对同济医院2006年12月至2007年12月68例肝癌患者行肝段切除术,根据术中是否束紧阻断带,将患者分为不阻断入肝血流组(37例)和阻断入肝血流组(31例),采用x2、t检验比较两种手术的情况.结果 术中失血量:不阻断入肝血流组为(400±100)ml;阻断入肝血流组为(350±100)ml,两组比较差异无统计学意义(t=0.717,P＞0.05).术后ALT恢复时间:不阻断入肝血流组为(6±2)d;阻断入肝血流组为(10±3)d,两组比较差异有统计学意义(t=6.006,P＜0.05).术后并发症发生率:不阻断入肝血流组为14%(5/37);阻断入肝血流组为35%(11/31),两组比较差异有统计学意义(t=4.525,P＜0.05).结论 不阻断入肝血流肝段切除术可有效防止肝脏缺血再灌注损伤,降低术后并发症发生率,是安全可行的.

Effects of hepatic segmentectomy without hepatic blood inflow occlusion on hepatic function of patients with hepatocellular carcinoma

Objective To investigate the safety and technique of hepatic segmentectomy without hepatic blood inflow occlusion.and to detect its influences on the function of the remnant liver and postoperative complications.Methods The clinical data of 37 hepatocellular carcinoma patients who had undergone hepatic segmentectomy without hepatic blood inflow occlusion(group A)in Tonal Hospital from December 2006 to December 2007 were retrospectively analyzed.The clinical data of 3 1 patients who were treated by hepatic segmentectomy with Pringle maneuver(group B)during the same period of time were used as control.The efficacy of the 2 treating methods was analvzed bv chi-square test and t test.Results The difference of perioperative blood losses between group A[(400±100)ml]and B[(350±100)ml]had statistical significance(t=0.717,P＞0.05).The time of alanine transaminase returning to the normal level in group A was(6±2)days,which was significantly shorter than(10±3)days in group B(t=6.006,P＜0.05).The postoperative complication rates of group A and B were 14%(5/37)and 35%(11/31),respectively,with statistical difference between the 2 groups(t=4.525.P＜0.05).Conclusions Hepatic segmentectomy without hepatic blood inflow occlusion can effectively prevent the hepatic ischemia reperfusion injury and reduce the postoperative complications.