大肝癌手术切除术中不同肝血流阻断方法的临床研究

目的：比较大肝癌手术切除术中3种不同的入肝血流阻断法的临床效果。
　　方法：回顾性分析2011年1月—2013年3月期间218例大肝癌（>5cm）手术患者的临床资料，术中88例采用Pringle法间断阻断全肝血流（肝门阻断组），51例行选择性的半肝血流阻断（半肝阻断组），79例行肝下下腔静脉阻断联合Pringle法阻断入肝血流（联合阻断组）。比较3组患者的术中与术后的相关指标。
　　结果：3组患者的术前情况、手术时间、入肝血流阻断时间及肝切除量的差异均无统计学意义（均P>0.05）；半肝阻断组与联合阻断组的术中出血量、输血量、输血率均明显低于肝门阻断组，且联合阻断组的输血量、输血率明显低于半肝阻断组（均P<0.05）；3组患者术后第1天肝功能指标差异无统计学意义（均P>0.05），但半肝阻断组与联合阻断组第3、7天的转氨酶和总胆红素水平均明显低于肝门阻断组（均P<0.05）；3组术后并发症的发生率差异无统计学意义（P>0.05）。
　　结论：大肝癌切除术术中采用肝下下腔静脉阻断联合Pringle法阻断入肝血流不仅能够有效减少术中失血量，而且有利于术后肝功能的恢复。

Comparison of different hepatic inflow occlusion methods in hepatectomy for large liver cancer

Objective: To compare the clinical efficacies of three hepatic inflow occlusion methods in hepatectomy for large hepatocellular carcinoma. Methods: The clinical data of 218 patients undergoing hepatectomy for large hepatocellular carcinoma (>5 cm) from January 2011 to March 2013 were retrospectively analyzed. During surgery, 88 cases were subjected to intermittent hepatic inflow occlusion with Pringle maneuver (portal occlusion group), 51 cases underwent selective hemihepatic blood flow occlusion (hemihepatic occlusion group), and 79 cases received infrahepatic inferior vena cava (IVC) clamping plus Pringle maneuver (combination occlusion group). The relevant clinical variables among the three groups of patients were compared. Results: There were no significant differences in preoperative conditions, operative time, inflow occlusion time and liver resection volume among the three groups (all P>0.05). In either hemihepatic occlusion group or combination occlusion group, the intraoperative blood loss, blood transfusion volume and blood transfusion rate were all significantly lower than those in portal occlusion group, and the blood transfusion volume and blood transfusion rate in combination occlusion group were also significantly lower than those in hemihepatic occlusion group (all P<0.05). All liver function parameters showed no significant difference among the three groups on postoperative day (POD) one, but the transaminase and total bilirubin levels in both hemihepatic occlusion group and combination group were significantly decreased compared with portal occlusion group on POD 3 and 7 (all P<0.05). No significant difference was noted in incidence of postoperative complications among the three groups (P>0.05). Conclusion: In large liver cancer resection, hepatic inflow control with combination of infrahepatic IVC clamping and Pringle maneuver can not only effectively reduce intraoperative blood loss, but also be advantageous for recovery of postoperative liver function.