CAJ | 학술논문

目的比较3种入肝血流阻断方法,即Pringle法(A组)、半肝阻断法(B组)、单纯门静脉阻断法(C组)在肝切除术中的应用效果.方法采用随机对照研究的方法,将行肝切除术的患者随机分为3组,采用不同的阻断方法,对3组手术前后肝功能变化及术中出血及术后并发症进行比较.结果 B组中1例因分离单侧肝门困难而改用Pringle法;179例患者无围手术期死亡;术中出血量3组间较差异无统计学意义;术后第1、3、7天B组和C组的肝功能改变(总胆红素、丙氨酸氨基转移酶及蛋白水平等)组间比较无统计学意义,两组与A组比较有统计学意义.结论 3种入肝血流阻断方法在切肝过程中,控制术中出血效果满意,切肝过程中采用选择性入肝血流阻断较Pringle法对术后肝功能损伤较小.
목적 비교3충입간혈류조단방법,즉Pringle법(A조)、반간조단법(B조)、단순문정맥조단법(C조)재간절제술중적응용효과.방법 채용수궤대조연구적방법,장행간절제술적환자수궤분위3조,채용불동적조단방법,대3조수술전후간공능변화급술중출혈급술후병발증진행비교.결과 B조중1례인분리단측간문곤난이개용Pringle법;179례환자무위수술기사망;술중출혈량3조간교차이무통계학의의;술후제1、3、7천B조화C조적간공능개변(총담홍소、병안산안기전이매급단백수평등)조간비교무통계학의의,량조여A조비교유통계학의의.결론 3충입간혈류조단방법재절간과정중,공제술중출혈효과만의,절간과정중채용선택성입간혈류조단교Pringle법대술후간공능손상교소.
Objective To valuate different effects in hepatectomy of three inflow occlusion methods including pringle maneuver, hemihepatic occlusion and portal venous occlusion. Methods 180 patients undergoing hepatectomy were randomly assigned to pringle group (group A), hemehepatic occlusion group (group B)or PV occlusion group (group C). The amount of blood lost, measurements of liver enzymes alanine aminotransferase (ALT), aspirate aminotransferase (AST), total bilirubin (TB), Serum albumin (ALB) and postoperative complication were also recorded. Results There was no operative mortality. One patient in group B changed into pringle maneuver due to the difficulties in dissecting the hemi-hepatic portal and was excluded. The amount of hemorrhage of three groups had no statistical difference. The ALT, AST, ALB and TB level of 1,3,7 days after operation had significant differences in three groups. The pringle group had a higher level ALT,AST,TB and lower ALB level than the other two groups. Conclusions All techniques of occlusion are effective and feasible for patients undergoing hepatectomies. However, compared with pringle maneuver, PV clamping and hemihepatic occlusion can relieve the liver function damage after hepatectomy.