肝下下腔静脉阻断在肝切除术中控制出血的临床应用

摘要

如何有效地控制肝切除术中出血一直是肝胆外科领域研究的热点。肝脏有流入道和流出道两套血管系统，对肝脏的血流控制包括对流入道和流出道血流的控制。控制流入道出血有许多简单而有效的方法，而如何有效地控制流出道出血一直是个难题。学者们创立了许多方法，包括全肝血流阻断、选择性全肝血流阻断等，但是这些方法都存在一定的弊端，只在特定的患者中被采用。有学者发现通过降低中心静脉压可减少肝切除术中肝静脉系统的出血，但是对其有效性仍存在争议。近年来，有文献报道在第一肝门阻断的同时，阻断肝下下腔静脉即可有效减少肝切除时来自肝静脉系统的出血。此方法相对于其他控制肝脏流出道出血的方法都简单易行，在肝切除术中有很高的应用价值。本文对肝下下腔静脉阻断在肝切除术中应用的现状进行讨论，对其减少肝切除术中出血的有效性及安全性进行总结和评价。%Bleeding control is quite important during liver surgery.Bleeding during hepatectomy is mainly derived from inflow and outflow tract of liver.Many methods are available for occluding in-flow blood while bleeding control of outflow tract remains problematic.Total hepatic vascular exclu-sion (THVE)and selective hepatic vascular exclusion (SHVE)may reduce bleeding from hepatic veins,but their applications are limited because of high complication rates and handling difficulties. Low central venous pressure is believed to reduce bleeding from a backflow of hepatic veins during transection by some surgeons,but its effectiveness remains controversial.In resent years,several au-thors reported that blood loss during hepatectomy could be reduced by clamping infra-hepatic inferior vena cava (IVC).This method is simpler and safer than others for controlling a backflow bleeding of hepatic veins.It reduces blood loss effectively during hepatectomy.This paper reviewed the applica-tion of infrahepatic IVC clamping for bleeding control during liver surgery.