肝血流阻断方法对肝切除术中大出血的影响

目的 分析不同肝血流阻断方法对肝切除术中大出血的影响.方法 回顾性分析1995年1月至2009年8月收治的接受肝切除术的2238例患者的临床资料,分析其中大出血(出血量≥1000 ml)的原因、不同肝血流阻断方法切肝时术中的出血量及大出血的发生率.结果 全组共有215例(9.6%)发生大出血,主要原因依次为门静脉主干取癌栓出血(26.0%)、肿瘤周围广泛粘连出血(24.7%)、肝断面出血(23.7%)、肝血管损伤出血(15.8%)及肿瘤破裂出血(9.8%);无门静脉主干取癌栓的2182例肝切除中,159例(7.3%)发生大出血,1257例(57.6%)出血量≤400 ml.不同肝血流阻断方法下肝切除术中出血量及大出血发生率不同.结论 Pringle联合肝下下腔静脉阻断法和经肝裸区隧道肝脏双悬吊法能更有效减少肝切除术特别是巨大肝肿瘤切除的出血量和大出血发生率.遵循"安全、有效、简便"的原则可根据肝肿瘤大小及位置、肝硬化程度及肝功能代偿情况、术者经验和条件采用不同的切肝方法,能有效减少术中出血量.

The effect of different hepatic vascular exclusions for massive hemorrhage in hepatectomy

Objective To analyze the effect of different hepatic vascular exclusions for massive hemorrhage in hepatectomy. Methods The clinical data of 2238 cases with hepatectomy treated from January 1995 to August 2009 was analyzed retrospectively in the cause of massive hemorrhage(blood loss≥1000 ml), blood loss during liver resection and massive hemorrhage incidence with different methods of hepatic vascular exclusion. Results Among 2238 cases received hepatectomy, 215 cases (9. 6%) had massive hemorrhage because of portal vein tumor thrombus extraction (26. 0%), extensive adhesions around the tumor(24. 7%), section of liver hemorrhage (23.7%), hepatic vascular injury (15.8%), and tumor rupture(9. 8%). Among 2182 cases received hepatectomy without portal vein tumor thrombus extraction,159 cases(7. 3%)had massive hemorrhage, 1257 cases(57. 6%)which blood loss were less than 400 ml.Hepatectomy with different hepatic vascular exclusion methods had different blood loss and massive hemorrhage incidence. Conclusion Pringle combined with clamping infrahepatic vena cava method and the liver double-hanging maneuver through the retrohepatic avascular tunnel on the right of the inferior vena cava method can reduce blood loss and massive hemorrhage incidence in hepatectomy more effectively, especially for huge liver tumor resection.