CAJ | 학술논문

如何有效地控制肝切除术中出血一直是肝胆外科领域研究的热点。肝脏有流入道和流出道两套血管系统，对肝脏的血流控制包括对流入道和流出道血流的控制。控制流入道出血有许多简单而有效的方法，而如何有效地控制流出道出血一直是个难题。学者们创立了许多方法，包括全肝血流阻断、选择性全肝血流阻断等，但是这些方法都存在一定的弊端，只在特定的患者中被采用。有学者发现通过降低中心静脉压可减少肝切除术中肝静脉系统的出血，但是对其有效性仍存在争议。近年来，有文献报道在第一肝门阻断的同时，阻断肝下下腔静脉即可有效减少肝切除时来自肝静脉系统的出血。此方法相对于其他控制肝脏流出道出血的方法都简单易行，在肝切除术中有很高的应用价值。本文对肝下下腔静脉阻断在肝切除术中应用的现状进行讨论，对其减少肝切除术中出血的有效性及安全性进行总结和评价。
여하유효지공제간절제술중출혈일직시간담외과영역연구적열점。간장유류입도화류출도량투혈관계통，대간장적혈류공제포괄대류입도화류출도혈류적공제。공제류입도출혈유허다간단이유효적방법，이여하유효지공제류출도출혈일직시개난제。학자문창립료허다방법，포괄전간혈류조단、선택성전간혈류조단등，단시저사방법도존재일정적폐단，지재특정적환자중피채용。유학자발현통과강저중심정맥압가감소간절제술중간정맥계통적출혈，단시대기유효성잉존재쟁의。근년래，유문헌보도재제일간문조단적동시，조단간하하강정맥즉가유효감소간절제시래자간정맥계통적출혈。차방법상대우기타공제간장류출도출혈적방법도간단역행，재간절제술중유흔고적응용개치。본문대간하하강정맥조단재간절제술중응용적현상진행토론，대기감소간절제술중출혈적유효성급안전성진행총결화평개。
Bleeding control is quite important during liver surgery.Bleeding during hepatectomy is mainly derived from inflow and outflow tract of liver.Many methods are available for occluding in-flow blood while bleeding control of outflow tract remains problematic.Total hepatic vascular exclu-sion (THVE)and selective hepatic vascular exclusion (SHVE)may reduce bleeding from hepatic veins,but their applications are limited because of high complication rates and handling difficulties. Low central venous pressure is believed to reduce bleeding from a backflow of hepatic veins during transection by some surgeons,but its effectiveness remains controversial.In resent years,several au-thors reported that blood loss during hepatectomy could be reduced by clamping infra-hepatic inferior vena cava (IVC).This method is simpler and safer than others for controlling a backflow bleeding of hepatic veins.It reduces blood loss effectively during hepatectomy.This paper reviewed the applica-tion of infrahepatic IVC clamping for bleeding control during liver surgery.