肝癌肝切除术中肝血流阻断方法的临床研究
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张奇, Email: dq_zhangqi@163.com

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Selection of hepatic blood flow occlusion method during liver cancer resection
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    摘要:

    目的:探讨肝癌切除术中不同肝血流阻断方法的合理选择。 方法:回顾性分析124例肝癌肝切除患者资料,根据术中血流阻断方法分为A组(51例行全肝入肝血流阻断),B组(38例行选择性入肝血流阻断),C组(24例行选择性出入肝血流阻断),D组(11例行半肝血流完全阻断)。比较4组患者手术时间、肝脏缺血时间、术中出血、输血量,术后肝功恢复情况、术后并发症发生率及病死率等。 结果:各组间术前基本情况无统计学差异(均P>0.05)。各组在肝缺血时间、术后并发症发生率及病死率等方面无统计学差异(均P>0.05);C组和D组手术时间明显长于A组(均P<0.05),但术中出血量、输血量均少于A组和B组(均P<0.05);A组术后丙氨酸转氨酶(ALT)总胆红素(TBIL)与水平升高较为明显,前者与其余3组间差异均有统计学意义,后者与B组间差异有统计学意义(均P<0.05)。 结论:肝血流阻断方法的合理选择须由肿瘤大小、位置,术前肝功能状况、潜在肝病、心脑血管状态等因素综合决定,而最重要的是依靠术者的经验与判断力。

    Abstract:

    Objective: To investigate the proper options for different hepatic blood flow occlusion methods during liver cancer resection. Methods: The data of 124 patients undergoing liver cancer resection were respectively analyzed. According to the method of blood flow occlusion, patients were divided into group A (51 cases undergoing total hepatic inflow occlusion), group B (38 cases undergoing selective inflow occlusion), group C (24 cases undergoing selective inflow and outflow occlusion) and group D (11 cases undergoing complete hemihepatic vascular occlusion). The operative time, duration of hepatic ischemia, intraoperative blood loss, blood infusion requirement, postoperative liver function recovery and incidence of postoperative complications as well as mortality among the 4 groups were compared. Results: The general conditions among groups showed no significant differences before operation (all P>0.05). There were no significant differences among the 4 groups with regard to the duration of hepatic ischemia, incidence of postoperative complications and mortality (all P>0.05). The operative time in both group C and group D were significantly prolonged versus group A (both P<0.05), but their intraoperative blood loss and infusion requirements were less than those in group A or group B (all P<0.05). The postoperative levels of alanine aminotransferase (ALT) and total bilirubin (TBIL) in group A were increased relatively higher than those of other groups, as the former showed significant difference versus all other groups, and the latter versus group B reached a statistical significance (all P<0.05). Conclusion: Proper selection of method of hepatic blood flow occlusion is based on overall consideration of several factors such as the size and location of the tumor, preoperative liver function, underlying liver disease, and function of cardio-cerebral vascular system. It also, greatly depends on the surgeon’s judgment and experience.

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张奇|王洪波|彭晓晖|刘振文|张佳斌|任辉.肝癌肝切除术中肝血流阻断方法的临床研究[J].中国普通外科杂志,2013,22(7):841-845.
DOI:10.7659/j. issn.1005-6947.2013.07.005

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  • 收稿日期:2013-05-23
  • 最后修改日期:2013-07-01
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  • 在线发布日期: 2013-07-15