肝切除术中血流阻断方式的选择

目的:比较3种解剖性血流阻断方案与对应的预阻断方案在肝脏肿瘤切除术中的应用价值,为肝切除术中最佳血流阻断方式的选择提供参考。方法:开展非随机同期对照试验,纳入240例肝脏肿瘤行开腹手术患者,划分为3个大组和6个小组,每小组各40例:半肝血流阻断组(A1组)及预阻断组(A2组)、门静脉主干阻断组(B1组)及预阻断组(B2组)、保留半肝门静脉的肝门阻断组(C1组)及预阻断组(C2组),比较各组临床疗效。结果:(1)各直接阻断组与预阻断组比较,差异均有统计学意义(P<0.05):预阻断组术中出血量明显更少,术后输血例数明显更少,术后3 d凝血酶原活动度明显更高;(2)3个大组比较差异有统计学意义(P<0.05):接受输血患者术中,出血量按C1及C2、B1及B2、A1及A2组依次明显增加,术后通气时间按A1及A2、C1及C2、B1及B2组依次明显延长,术后3 d ALT及AST水平按B1及B2组、A1及A2组、C1及C2组依次明显增加。结论:3组解剖性血流阻断方案均有一定适用性,但通过血流预阻断技术均有助于控制术中出血,减少术后输血,促进肝功能恢复。

The choice of blood flow occlusion in hepatectomy

Objective:By comparing the three kinds of anatomical blocking solutions and the corresponding pre blocking blood flow in the liver tumor resection,the application of value for the selection of best way to block blood flow in liver resection for reference. Methods:To carry out a non-randomized controlled trial during this period,the included 240 patients with liver tumor line open opera-tion,and is divided into three groups,6 groups,group of each 40 cases:half liver blood flow blocking group (A1 )and preliminary blocking group (group A2),the main portal vein blocking group (group B1 )and preliminary blocking group (group B2),liver portal vein of retain half door block group (C1 )and preliminary blocking group (C2),the comparison between groups of clinical curative effect.Results:(1 )The direct blocking group compared with pre block set,the following differences were significant (P <0.05 )that the bleeding amount of preliminary blocking group significantly less and less postoperative blood transfusion were obviously,3 d postop-erative prothrombin activity significantly higher;(2)three big contrast group,the following difference were significant (P <0.05 ):bleeding amount of patients given by C1 and C2,B1 and B2,A1 and A2 group significantly increased in turn,the aeration time accord-ing to the A1 and A2,C1 and C2,B1 and B2 group significantly extended in turn,postoperative 3 d ALT and AST level according to B1 and B2,A1 and A2 and C1 and C2 group significantly increased in turn.Conclusion:The 3 groups of anatomical blood flow blocking scheme have certain applicability,but through the bloodstream pre blocking technology helps control intraoperatie bleeding,postopera-tive blood transfusion and promote the recovery of liver function.