肝癌切除术中肝血流阻断方法的临床研究

目的 探讨肝癌切除术中不同肝血流阻断方法的合理选择. 方法 回顾性分析2003年4月至2007年8月收治的资料完整的124例肝癌切除患者的临床资料,根据术中血流阻断方法分为:A组(51例),全肝入肝血流阻断法;B组(38例),选择性入肝血流阻断法;C组(24例),选择性出、人肝血流阻断法;D组(11例),半肝血流完全阻断法.比较四组患者手术时间、肝脏缺血时间、术中出血及输血量、术后肝功能恢复情况、术后并发症发生率及病死率等指标. 结果 术前基本情况比较四组间无明显差异(P>0.05).C组和D组手术时间明显长于A组(P<0.05),但术中出血量、输血量均少于A组和B组(P<0.05).四组在肝缺血时间、术后并发症发生率及病死率等方面无明显差异(P>0.05).但A组术后谷氨酸转氨酶水平明显高于其他三组(P<0.05),A组术后总胆红素恢复情况与B组有明显差异(P<0.05). 结论 肝切除术中每一种肝血流阻断方法都有其应用价值.阻断方法的合理选择由肿瘤大小、位置、术前肝功能状况、潜在肝病、心脑血管状态等因素综合决定,其中最重要的是术者手术经验及权衡利弊的能力.

Clinical study of the method of hepatic vascular occlusion during resection of fiver carcinoma

Objective To evaluate the optimal method for hepatic vascular occlusion during resection of liver carcinoma. Methods One hundred and twenty-four patients with liver carcinoma were divided into four groups of hepatectomy with total hepatic inflow occlusion (group A,51 cases), selective hepatic inflow occlusion (group B, 38 cases ), selective exclusion of hepatic inflow and outflow (group C, 24 cases) and total hemihepatie vascular exclusion( group D, 11 cases). The time of operation and hepatic vascular occlusion, intraoperative blood loss and transfusion, postoperative liver function, complications and mortality were compared among the four groups. Results There were no significant difference among the four groups statistically in preoperative basic states ( P > 0. 05 ). The duration of operation was prolonged significantly in group C and D than that of group A, but intra-operative blood loss and transfusion requirements were decreased significantly in group C and D versus group A and B ( P < 0.05 ). There was no significant difference among the four groups regarding ischemia time, postoperative complications and mortality ( P > 0. 05 ). The level of postoperative alanine aminotransferase was higher in group A than other three groups (P < 0. 05 ). The postoperative total bilirubin increased significantly in group A contrast to group B ( P < 0. 05 ). Conclusions Each hepatic vascular occlusion technique has its place in liver resection. The size and location of tumor, preoperative liver function, underlying liver disease, cardiovascular and cerebral vessels status, and most important the experience and capability to weigh the merits and demerits of the surgeon should be taken into account to select the most appropriate occlusion method.