不同肝血流阻断方法在肝切除术中的效果比较

目的比较Pringle法（Pringle组）、选择性门脉血流阻断法（selective portal venous exclusion,SPVE,SPVE组）及Glisson鞘选择性入肝血流阻断法（selective Glisson sheath exclusion,SGSE,SGSE组）在肝脏切除手术中的效果及临床意义。方法回顾性分析2006年8月至2012年3月期间于中南大学湘雅医院采用上述3种肝脏血流阻断方法行肝脏切除手术患者的临床资料,比较3组患者的手术时间、血流阻断时间、失血量、输血率、术后肝功能、并发症发生率及住院时间指标。结果 3组患者的术前情况、手术时间、血流阻断时间、肿瘤特征、术后血常规及肝功能、住院时间及ICU时间的差异均无统计学意义（P〉0.05）;SGSE组患者的术中出血量及输血者比率均明显少或低于Pringle组和SPVE组（P〈0.05）;SPVE组和SGSE组术后各时间（除术后第1天外）的AST及ALT较Pringle组改善明显（P〈0.05）,TBIL在第3、5天较Pringle组显著改善（P〈0.05）;SPVE组和SGSE组的并发症发生率低于Pringle组（P〈0.05）。结论 SGSE法能够在相似的手术时间和血流阻断时间内,能更好地控制患者的术中出血量与输血率,有利于术后肝功能的恢复,并降低了术后并发症的发生,具有一定的优越性。但手术时仍要根据实际情况选择阻断方式。

Effects of Different Hepatic Inflow Occlusion Methods for Hepatectomy

Objective To evaluate different clinical effects of three inflow occlusion methods in hepatectomy including pringle maneuver （Pringle group）, selective portal venous exclusion （SPVE group）, and Glissonean pedicle exclusion （SGSE group）. Methods The clinical data of patients underwent the liver resection with the above liver inflow occlusion methods were retrospectively analyzed. The operation time, inflow occlusion time, amount of intraop- erative blood loss, transfusion rate, and postoperative hepatic function and complication rate were compared for each group. Results There were not significant difference of preoperative conditions, operation time, inflow occlusion time, tumor character, postoperative liver function, hospital time, and ICU time （P〉 0. 05）. The amount of intraoperative blood loss and rate of blood transfusion of SGSE group were significantly less （lower） than those Pfingle group and SPVE group （P〈0. 05）. In addition to the first day after operation, the AST and ALT at other time point of SPVE group and SGSE group were improved than that Pringle group （P〈0. 05）, while TBIL at the third and fifth day after operation of Pringle group were improved （P〈 0. 05）. The complication rates of SPVE group and SGSE group were significantly lower than that of Pringle group （P〈0. 05）. Conclusions In the similar operatin time and inflow occlusion time, Glissonean pedicle exclusion method can control the intraoperative blood loss and blood transfusion better, and can promote the patient recovery. Besides, the inflow occlusion methods should be selected based on the practical condition of patients.