合理阻断肝脏血流切除累及肝门区肿瘤

目的探讨肝脏血流阻断技术在累及肝门区肿瘤切除中的合理应用。方法对采用第一肝门阻断法（Pringle法）和常温下全肝血流阻断法（THVE）相结合切除14例累及肝门区肿瘤的临床资料进行回顾性分析,统计肿瘤和肝门区血管的毗邻关系、阻断次数、阻断时间、术中出血量、输血量、术后并发症等指标。结果本组Pringle法平均阻断（4.2±2.0）次,第一肝门平均阻断时间（49.6±30.8）min;THVE平均阻断（1.8±0.4）次,平均阻断时间（18.8±7.4）min;术中出血量平均（1100±360）ml,输血量平均（800±220）ml;术中修补下腔静脉4次,主肝静脉2次,门静脉主干2次;术后检测ALT、胆红素有不同程度升高,经治疗2～3周后恢复正常,未发生肝功能衰竭、肝肾综合征等严重并发症。结论Pringle法与THVE法分步结合使用可增加肝门区肿瘤切除的安全性。

THE REASONABLE USE OF HEPATIC BLOOD FLOW EXCLUSION FOR RESECTION OF LIVER TUMORS INVOLVING HEPATIC HILAR REGION

Objective To study the reasonable way of hepatic blood flow exclusion for resection of liver tumors involving hepatic hilar region. Methods The clinical data of 14 cases of liver tumors involving hepatic hilar region were retrospectively analyzed. These liver tumors were resected by combining the first hepatic portal control （Pringle maneuver） and normothermic total hepatic vascular exclusion （THVE）. These index including the relation of liver tumors and important vessels, numbers and times of hepatic blood flow exclusion, intraoperative blood loss and blood transfusion, postoperative complications were analyzed. Results The technique combining Pringle maneuver and THVE was performed in 14 cases. The mean numbers and times of Pringle maneuver were （4. 2 ± 2. 0） and （49. 6±30. 8） min, respectively. The mean numbers and times of THVE were （1.8±0.4） and （18. 8±7. 4） min, respectively. The mean amount of intraoperativ blood loss was （ 1100 ± 360） ml, blood transfusion （800 ±220） ml. During resections, inferior vena cave were repaired in 4 cases, main hepatic veins in 2 cases, portal veins in 2 cases. The serum alanine transaminase （ALT） and bilirubin raised in different degree after operation. But these index recovered gradually normal level in 2-3 weeks after treatment. There were no liver function failure and other serious postoperative complications and all the patients were cured. Conclu- sions The technique of stepped hepatic blood flow exclusion combining pringle maneuver and THVE can improve safety for resection of hver tumors involving hepatic hilar region.