肝提带配合半肝血流阻断在肝切除术中的应用

摘要

目的 探讨肝提带配合半肝血流阻断在肝切除手术中的价值.方法 回顾64例肝癌肝切除术患者的临床资料,比较行肝提带配合半肝血流阻断(实验组n=24)和半肝血流阻断法(对照组,n=40)在肝切除手术中的应用价值.结果 对照组平均手术时间(205.1±55.4)min,实验组平均手术时间(214.3±54.6)min,两者之间无显著性差异(P>0.05);对照组平均失血总量(497.3±63.0)ml,无需输血治疗;实验组平均失血总量(203.0±39.4)ml,无需输血治疗;两者之间存在统计学差异(P<0.05);术后第1、3 d实验组ALT浓度低于对照组,分别为(232.2±109.2)U/L vs.(434.8±215.7)U/L和(124.8±67.8)U/L vs.(241.6±132.6)U/L(P<0.05),术后第1 d实验组TBIL低于对照组分别为(45.2±17.8)μmol/L vs.(55.7±34.1)μmol/L(P<0.05).结论 肝提带配合半肝血流阻断在肝切除术中是安全可行的,能显著减少术中出血,缩短手术时间,有利于降低手术风险和术后恢复.%Objective To assess the value of hepatectomy using the hemihepatic inflow interruption combined with liver hanging maneuver. Methods Clinical data of 64 patients with hepatocellular carcinoma were reviewed. Hepatectomy using hemihepatic inflow interruption combined with liver hanging maneuver was performed in 24 cases ( experimental group, n = 24 ), while the other 40 cases managed with hepatectomy using the hemihepatic inflow interruption ( control group, n = 40 ). Results There was no difference between the experimental group and control group in the operative time, with( 214.3 ± 54.6 ) min vs. ( 205.1 ±55.4) min ( P ＞ 0.05 ). There was no difference between the experimental group and control group in the blood loss, with(203.0 ±39.4)ml vs. (497.3 ±63.0)ml (P ＜0.05). The serum ALT levels of 1,3 days after operation of the experimental group were lower than the control group, that was ( 232.2 ± 109.2 ) U/L vs. (434.8 ±215.7)U/L, and (124.8 ±67.8)U/L vs. (241.6 ± 132.6)U/L respectively(P ＜0.05).And the serum TBIL level of 1 day after operation in experimental group was obviously lower than the control group, (45.2 ±17.8) μmol/L vs. (55.7 ±34.1) μmol/L (P＜0.05). Conclusion Hepatectomy using the hemihepatic inflow interruption combined with liver hanging maneuver is safe and feasible, which can reduce intraoperative blood loss, shorten the operation time, reduce surgical risk and may be more helpful for the recovery of liver function.