CAJ | 학술논문

目的研究不同肝脏血流阻断技术对术中吲哚青绿滞留试验的影响.方法回顾性分析我院2009-2010年62例接受肝部分切除治疗肝癌患者的临床资料.其中A组13例术中未行肝门阻断；B组29例术中行第一肝门阻断(Pringle法)；C组20例术中行选择性入肝血流(肝动脉、门静脉)阻断.术前及术中均行分光脉动法吲哚青绿滞留试验.结果 (1)与A组比较,B组、C组术中出血量减少,差异有统计学意义(P=0.016,P=0.001).(2)三组患者术前吲哚青绿15 min滞留率(ICGR15)无明显差异,B组术中ICGR15明显高于A、C组(P=0.011,P=0.030).(3)三组患者术中ICGR15均较术前有所升高,其幅度与术中出血量(r=0.349,P=0.005)及第一肝门阻断总时间(r=0.484,P=0.001)有明显的相关性.(4)C组患者术后肝脏功能恢复情况优于A、B组患者.结论选择性入肝血流阻断技术既可以减少肝切除术中缺氧损伤又可以避免缺血再灌注损伤,有利于患者的术后康复,特别适用于合并肝硬化的患者.
목적 연구불동간장혈류조단기술대술중신타청록체류시험적영향.방법 회고성분석아원2009-2010년62례접수간부분절제치료간암환자적림상자료.기중A조13례술중미행간문조단；B조29례술중행제일간문조단(Pringle법)；C조20례술중행선택성입간혈류(간동맥、문정맥)조단.술전급술중균행분광맥동법신타청록체류시험.결과 (1)여A조비교,B조、C조술중출혈량감소,차이유통계학의의(P=0.016,P=0.001).(2)삼조환자술전신타청록15 min체류솔(ICGR15)무명현차이,B조술중ICGR15명현고우A、C조(P=0.011,P=0.030).(3)삼조환자술중ICGR15균교술전유소승고,기폭도여술중출혈량(r=0.349,P=0.005)급제일간문조단총시간(r=0.484,P=0.001)유명현적상관성.(4)C조환자술후간장공능회복정황우우A、B조환자.결론 선택성입간혈류조단기술기가이감소간절제술중결양손상우가이피면결혈재관주손상,유리우환자적술후강복,특별괄용우합병간경화적환자.
Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.