中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
6期
463-466
,共4页
张成武%赵大建%刘杰%金望迅%吴伟顶
張成武%趙大建%劉傑%金望迅%吳偉頂
장성무%조대건%류걸%금망신%오위정
肝切除术%止血,手术
肝切除術%止血,手術
간절제술%지혈,수술
Hepatectomy%Hemostasis,surgical
目的 探讨3种不同肝血流阻断方法对半肝切除术手术预后的影响.方法 总结分析216例半肝切除术患者的临床资料,按术中所采用的肝血流阻断方法将患者分为3组:Pringle法为A组98例,选择性出入肝血流阻断术为B组71例,肝悬吊法联合选择性出入肝血流阻断术为C组47例.结果 3组间平均手术时间差异无统计学意义(分别t =0.72,0.83,0.67,均P＞0.05)；A组平均术中出血量为和平均输血量均明显多于B、C组(分别t=3.72,3.83,4.11,4.07,均P＜0.05),B、C两组间差异无统计学意义(t=1.08,P＞0.05)；A组患者术后第1、3天血清白蛋白水平显著低于B、C组(分别t =3.65,3.77,3.90,3.74,均P＜0.05)；A组患者术后第3、5天血清总胆红素水平明显高于B、C组(分别t=4.13,5.01,4.09,3.99,均P＜0.05)；A组术后第1、3、5天血清丙氨酸转氨酶水平显著高于B、C组(分别t=5.36、6.14,5.70,7.01,4.94,3.98,均P＜0.05)；A组患者术后并发症发生率明显高于B、C组(分别x2 =13.71,23.56,均P＜0.05).B、C组患者术后肝功能变化及并发症发生率差异无统计学意义(均P＞0.05).3组恶性肿瘤患者的术后3年生存率差异无统计学意义(t=2.38,P＞0.05).结论 半肝切除术中采用选择性出入肝血流阻断术或与肝悬吊法联合应用,均可显著减少术中出血,减轻术后肝功能损害及降低术后并发症的发生率.选择性出入肝血流阻断术可作为半肝切除术中血流阻断的首选方法.
目的 探討3種不同肝血流阻斷方法對半肝切除術手術預後的影響.方法 總結分析216例半肝切除術患者的臨床資料,按術中所採用的肝血流阻斷方法將患者分為3組:Pringle法為A組98例,選擇性齣入肝血流阻斷術為B組71例,肝懸弔法聯閤選擇性齣入肝血流阻斷術為C組47例.結果 3組間平均手術時間差異無統計學意義(分彆t =0.72,0.83,0.67,均P＞0.05)；A組平均術中齣血量為和平均輸血量均明顯多于B、C組(分彆t=3.72,3.83,4.11,4.07,均P＜0.05),B、C兩組間差異無統計學意義(t=1.08,P＞0.05)；A組患者術後第1、3天血清白蛋白水平顯著低于B、C組(分彆t =3.65,3.77,3.90,3.74,均P＜0.05)；A組患者術後第3、5天血清總膽紅素水平明顯高于B、C組(分彆t=4.13,5.01,4.09,3.99,均P＜0.05)；A組術後第1、3、5天血清丙氨痠轉氨酶水平顯著高于B、C組(分彆t=5.36、6.14,5.70,7.01,4.94,3.98,均P＜0.05)；A組患者術後併髮癥髮生率明顯高于B、C組(分彆x2 =13.71,23.56,均P＜0.05).B、C組患者術後肝功能變化及併髮癥髮生率差異無統計學意義(均P＞0.05).3組噁性腫瘤患者的術後3年生存率差異無統計學意義(t=2.38,P＞0.05).結論 半肝切除術中採用選擇性齣入肝血流阻斷術或與肝懸弔法聯閤應用,均可顯著減少術中齣血,減輕術後肝功能損害及降低術後併髮癥的髮生率.選擇性齣入肝血流阻斷術可作為半肝切除術中血流阻斷的首選方法.
목적 탐토3충불동간혈류조단방법대반간절제술수술예후적영향.방법 총결분석216례반간절제술환자적림상자료,안술중소채용적간혈류조단방법장환자분위3조:Pringle법위A조98례,선택성출입간혈류조단술위B조71례,간현조법연합선택성출입간혈류조단술위C조47례.결과 3조간평균수술시간차이무통계학의의(분별t =0.72,0.83,0.67,균P＞0.05)；A조평균술중출혈량위화평균수혈량균명현다우B、C조(분별t=3.72,3.83,4.11,4.07,균P＜0.05),B、C량조간차이무통계학의의(t=1.08,P＞0.05)；A조환자술후제1、3천혈청백단백수평현저저우B、C조(분별t =3.65,3.77,3.90,3.74,균P＜0.05)；A조환자술후제3、5천혈청총담홍소수평명현고우B、C조(분별t=4.13,5.01,4.09,3.99,균P＜0.05)；A조술후제1、3、5천혈청병안산전안매수평현저고우B、C조(분별t=5.36、6.14,5.70,7.01,4.94,3.98,균P＜0.05)；A조환자술후병발증발생솔명현고우B、C조(분별x2 =13.71,23.56,균P＜0.05).B、C조환자술후간공능변화급병발증발생솔차이무통계학의의(균P＞0.05).3조악성종류환자적술후3년생존솔차이무통계학의의(t=2.38,P＞0.05).결론 반간절제술중채용선택성출입간혈류조단술혹여간현조법연합응용,균가현저감소술중출혈,감경술후간공능손해급강저술후병발증적발생솔.선택성출입간혈류조단술가작위반간절제술중혈류조단적수선방법.
Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy.Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively.Ninety-eight out of 216 patients received Pringle maneuver during hepatectomy in group A,71 patients of selective liver inflow and outflow vascular exclusions in group B,47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C.Results There was no difference in operation time between the three groups ( t =0.72,0.83,and 0.67,P ＞ 0.05 ).The intraoperative blood loss and transfusion in group B and C were less than that in group A (t =3.72,3.83 and 4.11,4.07,P ＜0.05).Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A (t =3.65,3.77,and 3.90,3.74,P ＜0.05 ).Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A ( t =4.13,5.01,and 4.09,3.99,P ＜0.05).Serum alanine aminotransferase on day 1,3 and 5 in group B and C were lower than that in group A ( t =5.36,6.14,and 5.70,7.01,and 4.94,3.98,P ＜ 0.05 ).Postoperative complication rate in group A was higher than that in group B and C ( x2 =13.71 and 23.56,P ＜ 0.05 ).The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different (t =2.38,P ＞ 0.05 ).Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced,and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging maneuver.
