连续性半肝血流阻断与间歇性全肝血流阻断肝切除的临床分析

摘要

Objective To evaluate if continuous hemihepatic inflow occlusion(HH)during hepatectomy can be as safe and effective as intermittent total hepatic inflow occlusion(TH)in reducing blood loss during hepatectomy.Methods From November 2001 to March 2006.eighty patients undergoing liver resections were included in a prospective randomized study comparning the intra-and postoperative course underTH(n=40)or HH(n=40).TH was performed with periods of 20 minutes of occlusion and 5 minutes of releasing,while HH with continuous occlusion.The surface area of liver transection was measured and blood loss was calculated.The amount of blood loss,levels of alanine aminotransferuse (ALT)and aspartate aminotransferase(AST),and postoperative course were recorded. Results The total ischemic time of the HH groups was longer than in the TH group[(42±13)min,(31±13)min,P=0.37],and the operative time in the HH group was longer than in the TH group[(236 ±49)min,(204±38)min,P=0.02 ].No signincant difierenee was found between HH and TH group in blood loss during liver parenchyma transection[(500 ±269)ml,(416 ±235)ml,P=0.14]and in the changes of ALT and AST on the first postoperative day[ALT:(677±572)IU/L,(577 ±327)IU/L,P=0.12;AST:(591 ±468)IU/L,(512±301)IU/L,P=0.66].There were no difierences on postoperative morbidity between the two groups(22.5%versus 20.0%,P=0.35).Conclusion The technique of continuous hemihepatic inflow occlusion is as safe and effective as intermittent total hepatic inflow occlusion.%目的 评价在肝切除术中连续性半肝血流阻断(hemihepatic inflow occlusion,HH)与间歇性全肝血流阻断(total hepatic inflow occlusion,TH)的安全性和有效性.方法 将80例肝肿瘤患者分为HH组(40例)和TH组(40例).术中施行肝切除时,HH组患者采用连续阻断血流的方式,TH组患者采用阻断血流20 min、复流5 min的阻断方式.测量2组患者的术中出血量和肝断面面积,术后1、3、7 d测定肝功能,并记录术后并发症情况.结果 HH组比TH组的肝总缺血时间长,分别为[(42±13)min,(31±13)min,P=0.00],HH组的手术时间(236±49)min比TH组(204±38)min的时间长(P=0.02).两组患者断肝出血量分别为(500±269)ml与(416±235)ml,差异无统计学意义(P=0.14),术后第1天ALT与AST升高水平比较,二组差异无统计学意义[(ALT:(677 ±572)IU/L,(577±327)IU/L,P=0.12;AST:(591±468)IU/L,(512±301)IU/L,P=0.66)].两组患者术后并发症发生率相近(分别为22.5%和20.0%,P=0.35).结论 在肝切除中,连续性半肝血流阻断与间歇性全肝血流阻断同样安全和有效.