CAJ | 학술논문

目的探讨原发性肝癌肝切除术中延长肝门阻断时限对手术失血量和肝功能的影响.方法回顾性总结2001年6月至2005年12月原发性肝癌肝切除术中一次肝门阻断时间≥30 min患者的临床资料(持续阻断组),并以累积肝门阻断时间在相同范围内但为常规间歇性阻断的患者作为对照(间歇阻断组),比较两组手术失血量、接受输血病例的比例以及术后肝功能恢复情况.结果持续阻断组共35例,间歇阻断组共38例,两组患者临床资料比较无明显差异(P>0.05);持续阻断组平均肝门阻断时间为(34.7±4.4)min(30～45 min),间歇阻断组为(35.3±4.2)min,两者差异无统计学意义(P>0.05);持续阻断组平均手术失血量为(660.0±655.8)ml,显著少于间歇阻断组的(1054.0±673.3)ml(P<0.05),接受输血患者的比例(48.6%)也显著低于间歇阻断组(78.9%)(P<0.01);两组患者术后肝功能均顺利恢复,术后并发症的发生率无明显差异(P>0.05).结论在肝功能代偿良好的复杂原发性肝癌肝切除术中肝门阻断时间可以持续30～45 min,与常规的间歇性阻断相比未增加对肝脏的损伤,但显著减少了手术失血量、降低了需要输血患者的比例.
목적 탐토원발성간암간절제술중연장간문조단시한대수술실혈량화간공능적영향.방법 회고성총결2001년6월지2005년12월원발성간암간절제술중일차간문조단시간≥30 min환자적림상자료(지속조단조),병이루적간문조단시간재상동범위내단위상규간헐성조단적환자작위대조(간헐조단조),비교량조수술실혈량、접수수혈병례적비례이급술후간공능회복정황.결과 지속조단조공35례,간헐조단조공38례,량조환자림상자료비교무명현차이(P>0.05);지속조단조평균간문조단시간위(34.7±4.4)min(30～45 min),간헐조단조위(35.3±4.2)min,량자차이무통계학의의(P>0.05);지속조단조평균수술실혈량위(660.0±655.8)ml,현저소우간헐조단조적(1054.0±673.3)ml(P<0.05),접수수혈환자적비례(48.6%)야현저저우간헐조단조(78.9%)(P<0.01);량조환자술후간공능균순리회복,술후병발증적발생솔무명현차이(P>0.05).결론 재간공능대상량호적복잡원발성간암간절제술중간문조단시간가이지속30～45 min,여상규적간헐성조단상비미증가대간장적손상,단현저감소료수술실혈량、강저료수요수혈환자적비례.
Objective To evaluate the influence of extended hepatic pedicle occlusion(HPO)on hepatic ischemic/repcrfusion(I/R)injury and intraoperative blood loss in major hepatectomy for primary liver cancer(PLC).Methods Between June 2001 and December 2005.a total number of 843 patients with PLC had been operated on.Those whose hepatic pedicle were occluded continuously for or longer than 30 min during hepatectomy were retrospectively reviewed(continuous HPO group)and compared to the patients whose hepatic pedicle were occluded for the same length of time but intermittently(intermittent HPO group).The amount of intraoperative blood loss,the percentage of the patients who needed blood transfusion and postoperative liver biochemical tests were compared between the two groups.Results There were 35 cases in continuous HPO group and 38 cases in intermittent HPO group with occlusion time between 30 min and 45 min.The two groups were matched for underlying liver disease,preoperative liver function,tumor size and location.major intrahepatic vessel involvements and the types and extensions of the hepatectomies.The mean intraoperative blood loss in continuous HPO group was significantly less than that in intermittent HPO group(660 ml vs.1 054 ml,P<0.05);accordingly,the percentage of patients who need blood transfusion in countinuous HPO group was significantly lower than that in intermittent HPO group(48.6% vs.78.9%,P <0.01).Patients in both of the groups were recovered smoothly after operation,with no occurrence of liver failure.Conclusions The hepatic pedicle can be continuously occluded for 30-45 min in cirrhotic patients with well compensated liver function.and when compared to routine intermittent HPO,continuous HPO significantly decreases the intraoperative blood loss and reduces the need for transfusion.Meanwhile it does not increase the hepatic I/R injury.