选择性肝血流阻断肝切除术的应用

目的探讨选择性肝血流阻断肝切除术的安全性和可行性。方法回顾性分析我院2002年3月至2006年10月行肝切除术65例,分为选择性肝血流阻断组（HVC,n=28）和第一肝门阻断组（Pringle,n=37）;比较两组病人术中出血量、手术时间、术后肝功能的恢复、术后两天的平均引流量以及术后并发症。结果两组病人术中出血量和手术时间均无显著性差异;HVC组术后3天和7天的血清谷丙转氨酶明显低于Pringle组,术后两天的平均引流量HVC组明显少于Pringle组;Pringle组有两例出现肝功能衰竭,其中1例死亡,HVC组没有肝功能衰竭及死亡病例。结论选择性肝血流阻断肝切除术安全、可行,较第一肝门阻断更有利于肝功能的恢复,减少肝功能衰竭的发生。

The use of selective hepatic vascular exclusion in hepatectomy

Objective To explore the safety and feasibility of selective hepatic vascular exclusion in hepatectomy.Methods From March 2002 to October 2006,The data of 65 cases of hepatectomy were analyzed retrospectively,including a group of selective hepatic vascular exclusion(HVC,n=28)and a group of Pringle' maneuver(Pringle,n=37).The operative bleeding volume,operative time,the recovery of postoperative liver function,mean drainage volume of two postoperative days and postoperative complication were compared between the two groups.Results There were no significant differences between the two groups in operative bleeding volume and operative time.Serum ALT value of the third and the seventh postoperative days in HVC group was significantly lower than that of the Pringle group.The mean drainage volume of the first two days in HVC group was significantly less than that of the Pringle group.There were 2 cases of liver failure in Pringle group and one of them died.No liver failure and death were found in HVC group.Conclusion Selective hepatic vascular control is safe and feasible in hepatectomy.It helps more to the recovery of liver function than the Pringle's maneuver.It can also reduce occurrence of liver failure.