常温下间断入肝血流阻断在肝叶切除术中的应用

目的总结常温下间断肝门阻断在肝叶切除术中的临床价值。方法将我院2008～2011年间采用常温下间断肝门阻断肝叶切除病例设立为A组，我院2000～2008年间采用连续肝门阻断肝叶切除术病例设立为B组，比较两组术中出血及术后肝功能恢复情况。结果A组术前黄疸患者胆红素术后第1、3、5、7天一直下降，ALT、AST术后第1天升高，第3天开始下降，第7天恢复正常。A组阻断时间明显长于B组，但A组平均术中出血量明显少于B组，A组术后7d，54例患者肝功能完全恢复（100％），明显高于B组（P〈0．05）。A组发生近期并发症5例，间断肝门阻断优良率为90．74％，B组术后发生近期并发症23例，连续肝门阻断优良率为78．30％，两组比较差异有统计学意义（P〈0．05）。结论肝叶切除术中常规行常温下间断肝门阻断可以明显降低出血率及肝功能损害率，提高肝叶切除率，减少并发症的发生。

Continuous versus intermittent hilar occlusion for hepatectomy

Objective To compare the effect of normothermic continuous and intermittent portal triad clamping in hepatectomy on postoperative recovery.Methods Patients who underwent hepatic resection between 2008 and 2011 by using intermittent hilar occlusion as group A,and were compared with patients who had hepatectomy under continuous hilar occlusion between 2000 and 2008 as group B.Results The bilirubin of group A patients with preoperative jaundice postoperative 1,3,5,7 had been declining,the ALT and AST increased after postoperative day 1,the three days began to decline,the seven days back to normal.Group A cross-clamping time was significantly longer than group B,the average intraoperative blood loss of group A was significantly less than group B,after 7 days,the liver function of group A complete recovery rate(100%) was significantly higher than group B(P < 0.05).Group A complication occurred in five cases,and intermittent portal triad clamping good rate was 90.74%;Group B postoperative complications in 23 cases,continuous portal triad clamping excellent rate was 78.30%,the difference was statistically significant(P < 0.05).Conclusion Intermittent hilar occlusion might be superior to continuous hilar occlusion in patients receiving hepatic resection in term of decreasing blood transfusion rate and less liver function damage.