经腹经心包全肝血流阻断肝切除术

目的 探讨经腹经心包全肝血流阻断方法在肝切除术中的地位。方法 2003年1月至2007年12月，安徽医科大学第一附属医院肝胆外科将38例肝切除术按血流阻断方法分为两组，传统全肝血流阻断组（THVE组)22例，经腹经心包全肝血流阻断组（经心包组）16例，分析应用不同血流阻断方法对术后肝功能及并发症发生的影响。结果 两组病人均成功切除肿瘤，两组手术时间、阻断时间及术后并发症发生率差异均无统计学意义（P＞0.05）。两组术后第3天和第7天血清丙氨酸转氨酶(ALT)之间差异有统计学意义（P<0.05），术后第7天血清天冬氨酸转氨酶(AST)之间差异有统计学意义（P<0.05），经心包组术后近期肝功能恢复快。结论 经腹经心包全肝血流阻断肝切除术可提高肿瘤切除率，改善病人预后。

Clinical research of the hepatectomy of total hepatic vascular exclusion by incisioning pericardium through the abdomen

Objective To investigate the importance of total hepatic vascular exclusion for hepatectomy by incisioning pericardium through the abdomen.Methods Hepatectomy was performed in 38 patients in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University between January 2003 and December 2007 by 2 different manners of hepatic vascular exclusion.Among them,22 patients received the routine total hepatic vascular exclusion(THVE) and 16 patients received total hepatic vascular exclusion for hepatectomy by incisioning pericardium through the abdomen(incisioning pericardium) .The type of hepatic vascular exclusion and the variation of postoperative liver function and complication were evaluated.Results All tumors were entirely removed.There was no significant difference in duration of operation and exclusion and incidence of complication between THVE group and incisioning pericardium group.ALT was significant lower in incisioning pericardium group in the 3 and 7 day postoperatively(P<0.05) ,and AST was significant lower in incisioning pericardium group in the 7 day postoperatively(P<0.05) .Conclusion The hepatectomy of total hepatic vascular exclusion by incisioning pericardium through the abdomen can elevate resection ratio and improve prognosis of patients.