CAJ | 학술논문

目的探讨选择性肝外血管阻断方法进行肝肿瘤切除术的临床应用和意义.方法自2005年6月-2008年8月,对43例肝肿瘤切除术患者分别采用选择性肿瘤侧肝外血管游离阻断或结扎以及建立肝后隧道放置阻断带联合阻断法(SHVE)(19例)和Pringle法(24例)两种不同的阻断方式进行比较.两组肿瘤大小:SHVE组6 cm×6 cm～12 cm×12 cm,平均9 cm×9 cm.Pringle组6cm×6 cm～11 cm×11 cm,平均8 cm×8 cm.两组手术方式(叶或段切除):SHVE组Ⅱ～Ⅴ 4例,Ⅰ～Ⅳ 1例,Ⅳ+Ⅴ 2例,Ⅴ～Ⅷ9例,Ⅳ～Ⅷ3例.PrinCe组Ⅱ～Ⅴ 10例,Ⅳ+Ⅴ1例,Ⅳa～Ⅷ1例,Ⅴ～Ⅶ4例,Ⅴ～Ⅷ8例.将两组患者术中失血量、输血量、术中和术后并发症以及术后住院时间进行分析比较.结果 SHVE阻断组患者顺利将肿瘤侧肝动脉、门静脉结扎和肝静脉并予以结扎或置阻断带(其中肝右静脉出现小破裂口2例)和放置肝后下腔静脉阻断带.两组术中出血量、输血量和术后住院时间相比差异有统计学意义(分别t=3.93、3.19和3.04,均P<0.01).在术后第3天和7天肝功能的ALT、TBIL、PT变化情况相比差异有统计学意义(分别t=3.97、6.15、3.62、7.25、3.02、3.19,均P<0.01).结论由于SHVE的肝肿瘤切除术其血流阻断只限于肿瘤一侧肝组织,故阻断时间可以不受到时间的严格限制,同时可以减少术中出血、防止预留侧肝再灌注损伤,对促进患者术后肝功能的恢复均有重要的实用意义.
목적 탐토선택성간외혈관조단방법진행간종류절제술적림상응용화의의.방법 자2005년6월-2008년8월,대43례간종류절제술환자분별채용선택성종류측간외혈관유리조단혹결찰이급건립간후수도방치조단대연합조단법(SHVE)(19례)화Pringle법(24례)량충불동적조단방식진행비교.량조종류대소:SHVE조6 cm×6 cm～12 cm×12 cm,평균9 cm×9 cm.Pringle조6cm×6 cm～11 cm×11 cm,평균8 cm×8 cm.량조수술방식(협혹단절제):SHVE조Ⅱ～Ⅴ 4례,Ⅰ～Ⅳ 1례,Ⅳ+Ⅴ 2례,Ⅴ～Ⅷ9례,Ⅳ～Ⅷ3례.PrinCe조Ⅱ～Ⅴ 10례,Ⅳ+Ⅴ1례,Ⅳa～Ⅷ1례,Ⅴ～Ⅶ4례,Ⅴ～Ⅷ8례.장량조환자술중실혈량、수혈량、술중화술후병발증이급술후주원시간진행분석비교.결과 SHVE조단조환자순리장종류측간동맥、문정맥결찰화간정맥병여이결찰혹치조단대(기중간우정맥출현소파렬구2례)화방치간후하강정맥조단대.량조술중출혈량、수혈량화술후주원시간상비차이유통계학의의(분별t=3.93、3.19화3.04,균P<0.01).재술후제3천화7천간공능적ALT、TBIL、PT변화정황상비차이유통계학의의(분별t=3.97、6.15、3.62、7.25、3.02、3.19,균P<0.01).결론 유우SHVE적간종류절제술기혈류조단지한우종류일측간조직,고조단시간가이불수도시간적엄격한제,동시가이감소술중출혈、방지예류측간재관주손상,대촉진환자술후간공능적회복균유중요적실용의의.
Objective To study the clinical application of selective extrabepatic blocking in Hepatecto-my. Methods From June 2005 to August 2008, fourty-three patients undergone hepatectomy were divided into SHVC group of 19 cases and pringle group of 24 cases who underwent conventional hepatic vascular con-trol (CHVC). The neoplasms ranged from6 cm×6 cm to 12 cm×12cm, 9 cm×9 cm on average in diame-ter in the SHVE group. And in Pringle group, the diameter ranged from 6 cm × 6 cm to 11 cm×11 cm, 8 cm × 8 cm on average. We compared the parameters such as blood loss, transfusion, complications and length of stay of the two groups. Rsults Hepatectomy was successfully performed in the two groups, and in SHVC group hepatic veins were ligated or set blocker selectively according to the ailing hepatic lobes. There were significant differences between the two groups in the parameters including intraoperative blood loss( t = 3.93,P<0.01) ,intraoperative blood transfusion (t=3.19,P<0.01) and postoperative length of stay ( t = 3.04,P <0.01) and hepatic functions ( including serum alanine aminotransferase ( ALT), serum total bilirubin (TBIL), prothrombin time(PT) 3 and the 7clays after operation(P <0. 01 ). Conclusions The method of SHVE can reduce bleeding, avoid damages to main vessels, protect from injury of remnant liver reperfusion,avoid air embolus and so on. It is safe if done appropriately during the operation.