三种不同肝血流阻断方式在肝肿瘤切除术中的应用

目的探讨3种不同肝血流阻断方式在肝肿瘤切除术中的应用。方法将74例肝肿瘤患者根据肝血流阻断方式分为3组：A组（n=40）行pringle法，B组（n=23）行全肝血流阻断（THVE），C组（n=11）行解剖性肝血流（肝动脉、门静脉及肝静脉）阻断。并观察3组肝血流阻断时间、手术时间、出血量及并发症等情况。结果A组和B组手术时间均较C组显著缩短（均P〈0．01），B组肝门阻断前1min和肝门开放后1min中心静脉压均显著高于肝门阻断后（均P〈0．01），B组和C组出血量均较A组显著减少（均P〈0．01），A组和B组术后3dALT、AST水平均较c组显著升高（均P〈0．01），3组肝血流阻断后均未发生肾脏及心血管系统并发症。结论肝肿瘤行肝切除术时行pringle法血流阻断是一种简便方法，但出血量多；全肝血流阻断是一种减少出血的有效方法；解剖性肝血流阻断技术要求高，但术中肝损伤小，可避免缺血一再灌注损伤。

The Application of the Three Different Modes of Liver Blood Flow Blockade with Liver Tumor Excision

Objective To explore the application of three different modes of liver blood flow blockade for resection of liver cancer. Methods Seventy-four patients underwent different mode of liver blood flow blockade were randomly divided into 3 groups： group A（n=40） received the Pringle＇s,group B（n=23） received THVE and group C（n= 11） received anatomical blood flow blockade for the liver（Hepatic artery,portal vein and hepatic vein）. And catched on 3 groups of liver blood flow blockade time, operation time, amount of bleeding and complications, etc. Results The operation time of Group A or group B was significantly shortened than those of group C （P〈0.01, respectively）. Central venous pressure of 1 min before hepatic Portal triad clamping and 1 min after the opening of hepatic portal of goup B were significantly higher than that after hepatic portal blockade（P〈0.01, respectively）. The amount of bleeding in Group 13 or group C was significantly reduced than those in group A （P〈0.01 ,respectively）,3 days later ALT,AST level in group A or group B was significantly higher than those in group C （P〈0.01 ,respectively）,liver blood flow blockade group 3 did not happen after the kidney and cardiovascular complications. Conclusions The pringle is a simple method, but more amount of bleeding. Total liver blood flow blockade is a effective method and reducing loss of blood in resection of liver cancer. Anatomical of liver blood flow blockaed request higher technique,with small injury of liver and a- void ischemia-reperfusion injury.