单一腹主动脉阻断式无血切肝术与Pringle式及Heaney式的对照实验研究——兼论我国腹主动脉阻断式无血外科学科之率先建立

目的探讨单一腹主动脉阻断式下无血切肝术式的效果。方法1980年以来,我们进行了一系列常温下单一腹主动脉阻断(SAAC)实验研究,其结果首次证实犬SAAC安全时限为25min。在此时限内,仅有轻度可逆性的血液动力学,酸碱平衡、血液生化,以及主要脏器的超微结构变化;超过此时限,则将会导致不可逆难以代偿的体内严重病理生理变化。我们还进行了一系列SAAC式腹部无血外科实验研究。本实验中18犬被随机分成3组(各组n=6)做下列对照研究:单一腹主动脉阻断式无血切肝术"SAAC-BH式";Pringle’s式切肝术;Heaney式无血切肝术。结果(1)3组切肝术平均时间:A组5.80min,B组5.85min,C组5.90min,3组组间比较无显著性差异(P>0.05);(2)3组术中切肝平均出血量:A组5.60mL,B组28.40mL,C组5.80mL,A、C两组与B组相比较存在显著性差异(P<0.05);(3)A组6犬术后均苏醒与进食,并能长期生存;B、C组各有1犬与2犬死于术后1周之内;余犬术后均能苏醒与进食,并能长期生存;(4)SAAC-BH组阻断后与撤钳后均发生某些生理生化与脏器超微结构变化,均在可逆性范围之内。结论在严格遵循"二叉树耐受法则"条件下,SAAC-BH式(膈下,腹腔干动脉之上水平)像Heaney式一样均能达到无血切肝之目的,且能安全施行,控制术中出血优于Pringle’s式切肝式。本文提出现代肝脏切除术发展经过4个阶段,并将SAAC-BH式与现有切肝术各式家系做了详细利弊分析。最后指出,我国腹主动脉阻断式无血外科学科在国际上已率先建立。

Single Abdominal Aortic Cross-Clamping for Bloodless Hepatectomy Under Normothermic: Primitive Report of Experimental Study

Objective In order to find a new type of bloodless hepatectomy, Single abdominal aorta clamping for blot}d- less hepatectomy（SAAC - BH） was investigated for first time in this study. Methods We had carried out a series of experimental studies for single abdominal aorta clamping （SAAC） under normothermic condition since 1980; and our studies showed for the first time that 25 minutes is the safe time limit of SAAC in dogs. There are only small and re- versible changes in hemodynamic, acid - base equilibrium, blood biochemisty and in ultrastructures of main organs. If safe time limit exceed, it will induce severe changes, which may be irreversible and difficult to compensate. Based on these research results, a series of experimental study of abdominal bloodless surgery were executed. In this study, 18 dogs were divided into three groupes（each group; n = 6）; SAAC- BH is carried out in group A; Pringle＇ s clamping for hepatectomy is carried out in group B; Total hepatic flow occlusion for bloodless hepatectomy （THFO- BH, or Heaney＇s hepatectomy ） is executed in group C. Results （1） The average time for hepatectomy in 3 groups were respectively 5.80 min （Group A）,5.85min （Group B） and 5.90min（Group C） ,them was no significant difference（ P 〉 0.05） in inter - groups comparison. （2）The average amount of bleeding for hepatectomy were separately 5.60mL（group A）, 28.40mL（group B） and 5. 80mL（ group C）, there was a significant difference （ P 〈 0.05） in inter - groups comparison. （3） In group A, all 6 dogs of SAAC - BH were awake, eating, normal activities after operation and long- term survival; In group B, 1 dog died within 1 week after operation; 5 dogs were long - term survival; In group C, 4 dogs were long - term survival, except for 2 dogs died within 1 week af- ter operation. （4）After blocking and declamping, Some physiological, biochemical and uhrastructural indicators will happen mild changes but with the reversible range in all animals of A group. Conclusion The safety of animals will not be compromised, if the bintree tolerance law （BTL） is strictly followed during single abdominal aorta clamping （T12 level, above the celiac trunk artery） for bloodless hepatectomy （SAAC- BH） under normothermic condition. SAAC- BH can achieve the same operation effect as Heaney＇ s bloodless hepatectomy, and both are superior to Pringle＇ s hepetectomy with control bleeding during operation.