不同肝血流阻断技术在肝切除中应用的临床研究

目的研究半肝入肝血流阻断、出入半肝血流阻断和改良式Belghiti肝血流阻断无血半肝切除术在肝切除中临床运用价值。方法将同期96例需行半肝切除的患者分为半肝入肝血流阻断组（A组,n=24）、出入半肝肝血流阻断（B组,n=26）组、改良式Belghiti肝血流阻断组（C组,n=26）和第一肝门阻断组（D组,Pringle,n=20）。比较各组间患者术中出血量和手术时间,术后肝功能的恢复,术后血浆管引流量、输血量、术后并发症以及住院时间。结果 A、B、C、D4组患者术中出血量分别为（315±115）ml、（275±95）ml、（200±120）ml和（425±125）ml;C组出血量最少,但A、D两组比较差异无统计学意义。手术时间分别为（135±90）min、（145±65）min、（150±70）min和（140±85）min,4组间手术时间差异无统计学意义。A、B、C3组术后3d和7d的血清转氨酶明显低于Pringle组,且下降程度也较之明显。4组间术后3d的血浆引流总量分别为（185±30）ml、（150±20）ml、（100±30）ml和（250±80）ml,以Belghiti组引流量最少,Pringle组引流量最多。A、B、C、D4组出现并发症分别是4例（2/24）、3例（2/26）、2例（2/16）和6例（3/20）,Pringle组患者术后并发腹水显著高于A、B、C组。住院时间以D组最长,术后平均（8±4.5）d,C组住院时间最短,术后平均（6±3.5）d。A、B、C、D4组输血例数分别是4例（4/21）、2例（2/23）、0例（0/10）和（8/20）。结论半肝血流阻断法比第一肝门阻断更利于术后肝功能恢复,减少手术并发症,改良式Belghiti肝血流阻断肝切除技术是一种安全、实用、术后恢复快的切肝方法。

The clinics studying by difference liver vascular occlusion for the lobectomy

Objective To enhance the operation safety and clinics significance of lobectomy after occlusion of Pringle,hemihepatic vascular control,in-out hemihepatic vascular control and improvements Belghiti hemihepatic blood flow with randomized contrast analysis.Methods Ninety-six patients underwent hemihepatectomy were divided into four groups：Pringle group（n=20）,hemihepatic vascular control group（n=24）,in-out hemihepatic vascular control group（n=26）and improvements Belghiti hemihepatic blood flow group（n=26）.The amount of intraoperative bleeding,time of operation, postoperative liver function,liver function recovering and complications were compared between four groups.Results All operations were performed smoothly there were no difference in the time of operation between four groups.There were difference in the amount of intraoperative bleeding,postoperative liver function,liver function recovering and complications.The improvements Belghiti hemihepatic blood flow occulusion group had the lest in the amount of intraoperative bleeding,and the best at postoperative liver function recovering,and had the lest complications at the four groups.The improvements Belghiti hemihepatic blood flow group is significantly better than Pringle group. Conclusion The improvements Belghiti hemihepatic blood flow was an effective procedure and the safety can be enhance,and was a feasible and safe method resulting in fewer complications.