肝癌切除术中肝血流控制方法的选择

目的：探讨肝癌切除术中不同肝血流控制方法的合理选择。方法：回顾性分析94例肝癌患者行肝切除时采用4种不同肝血流控制方法对术后肝功能、手术时间、术中出血量、输血量、术后引流量及其并发症的影响。结果：38例（40.4%）行常规第一肝门阻断，34例（36.2%）行选择性半肝阻断，4例（4.3%）行全肝血流阻断，18例（19.1%）未阻断肝门。全部成功切除肿瘤，手术顺利，术后并发症24例次，术后死亡2例（2.1%）。结论：大肝癌切除时肝血流控制方法的选择应根据病变的大小、部位、肝功能、切肝难易程度及术中探查结果等因素综合决定。合理的肝血流控制方法是保证肝切除手术成功、患者术后顺利恢复的关键。

Selection of the method of hepatic vascular control during resection of liver carcinoma

Objective;To investigate the proper selection of methods of hepatic vascular control during resectionof liver carcinoma. Methods;Ninety foury cases of liver carcinoma underwent hepatectomy using 4 different types of hapatic vascular control in our hospital. The operative time, amount of intraoperative blood loss, transfusion, and postoperative drainage, changes of postoperative liver function and complications were analyzed and compared between the 4 groups. Results;Of the 94 cases, 38 (40.4%) underwent routine Pringle′s maneuver, 34 (36.2%) had selective hemihepatic vascular exclusion, 18(19,1%) without hepaticinflow occlasion and 4 (4.3%) had total vascular exclusion during hepatectomies. All tumors were entirely removed and operations were performed smoothly. Postoperative complications occurred 24 case times and 2 patients (2.1%) died. Conclusions;The selection of method of hepatic vascular control during hepatectomyfor massive liver carcinoma should be comprehensively determined, based on the size and location of tumor, preoperative liver function, diffculty of hepatectomy and findings at intraoperative exploration. Proper method manner of hepatic vascular control is crucial for successful operation and uneventful recovery of the patient.