选择性出入肝血流阻断技术在右半肝切除术中的应用

目的比较两种肝脏血流阻断方法在因肝脏恶性肿瘤行右半肝切除术中的作用，评价右半肝出入肝血流阻断技术在右半肝切除中的应用价值。方法将49例肝癌行右半肝切除的患者分为右半肝入肝血流阻断组（n=22）和右半肝出入肝血流阻断组（n=27）。比较两组患者术中出血量、输血患者比例、术后并发症以及术后肝功能的恢复等指标。结果两组患者术后输血比例差异无统计学意义（P〉0．05），右半肝入肝血流阻断组有1例患者术后死于肝脏功能衰竭。右半肝出入肝血流阻断组术后并发症数量明显减少、无患者死亡，术中出血量明显低于右半肝入肝血流阻断组（P〈0．05），且术后第7天的肝脏功能恢复明显优于右半肝入肝血流阻断组（P〈0．05）。结论右半肝出入肝血流阻断技术可以提高因肝脏肿瘤而行右半肝切除的成功率和患者对手术耐受性，为右半肝切除手术提供了一个安全、合理的手术方式。

Selective exclusion of hepatic outflow and inflow in right hemihepatectomy

Objective To evaluate the significance of selective exclusion of hepatic outflow and inflow in fight hemihepatectomy for hepatocarcinoma patients. Methods Forty - nine hepatocarcinoma patients underwent right hemihepatectomy were divided into two groups： selective exclusion of right hepatic inflow group （SEHI, n = 22 ） and selective exclusion of right hepatic outflow and inflow group （ SEHIO, n = 27 ）. The amount of intraoperative bleeding, rate of transfusion, complications, postoperative liver function and liver function recovering were compared between the two groups. Results There were no difference in the rate of transfusion between the two groups （ P 〉 0.05 ）. One patients in SEHI group died of liver function failure and no patient died in the SEHIO group. The liver function of 7th day after operation in SEHIO group was significantly better than that in SEHI group （ P 〈 0.05 ）. Complications in SEHI group was higher than in SEHIO group. Conclusions Both the two methods of selective fight hemihepatic blood flow control in this study can reduce the intraoperation bleeding. Selective exclusion of fight hemihepatic inflow and outflow is safer than the selective exclusion of right hepatic inflow in fight hemihepatectomy for patients with hepatocarcinoma and profit the recovery of postoperative hepatic function.