CAJ | 학술논문

目的探讨半肝血流阻断技术在合并肝硬化的肝癌手术治疗中的意义.方法回顾性分析山东大学齐鲁医院普外科2006年3月至2008年9月因肝癌行肝切除205例患者的临床资料,其中术中应用Pringle法第一肝门阻断入肝血流44例(A组)、半肝血流阻断76例(B组)、半肝血流阻断加选择性肝静脉控制85例(C组).比较3组患者肝切除手术时间和术中出血量,术后肝功能的恢复以及术后并发症.结果 3组患者肝切除手术时间比较差异无统计学意义(F=2.53,P>0.05);术中平均出血量分别为543.7、415.8、324.5 ml,3组间比较差异有统计学意义(F=98.96,P<0.001);在术后3 d和6 d的血清丙氨酸转氨酶、胆红素水平比较,B组和C组明显优于A组.结论半肝血流阻断可防止健侧肝脏缺血再灌注损伤;肝外控制肝静脉,可显著减少肝切除术中的出血量.
목적 탐토반간혈류조단기술재합병간경화적간암수술치료중적의의.방법 회고성분석산동대학제로의원보외과2006년3월지2008년9월인간암행간절제205례환자적림상자료,기중술중응용Pringle법제일간문조단입간혈류44례(A조)、반간혈류조단76례(B조)、반간혈류조단가선택성간정맥공제85례(C조).비교3조환자간절제수술시간화술중출혈량,술후간공능적회복이급술후병발증.결과 3조환자간절제수술시간비교차이무통계학의의(F=2.53,P>0.05);술중평균출혈량분별위543.7、415.8、324.5 ml,3조간비교차이유통계학의의(F=98.96,P<0.001);재술후3 d화6 d적혈청병안산전안매、담홍소수평비교,B조화C조명현우우A조.결론 반간혈류조단가방지건측간장결혈재관주손상;간외공제간정맥,가현저감소간절제술중적출혈량.
Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.