CAJ | 학술논문

目的探讨半肝血流完全阻断法(THHVE)在肝功能受损的肝细胞癌(简称肝癌)患者肝切除术中的应用价值.方法回顾分析2009年1月至201 1年10月行肝切除术的术前有肝功能损害的70例肝癌患者的临床资料.其中行THHVE38例(THHVE组),行Pringle法25例(Pringle法组),未行任何阻断7例.THHVE组男性36例,女性2例,平均年龄(54±9)岁；Pringle法组男性23例,女性2例,平均年龄(53±10)岁.比较两组术中总出血量、输血例数、阻断时间、并发症发生率、术后住院时间及术后肝功能恢复情况.结果 THHVE组与Pringle法组比较术中总出血量[(317±186) ml比(506±274) ml,t=-3.025,P=0.004]及需要输血的患者比例(10.5％比32.0％,x2=4.509,P=0.034)均明显低.THHVE组的血流阻断时间要长于Pringle法组[(21±5)min比(17±5)min,t=3.209,P=0.002],但THHVE组术后第3、7天的总胆红素及术后第1、3、7天的ALT均明显低于Pringle法组,术后第7天的前清蛋白明显高于Pringle法组.THHVE组与Pringle法组比较总并发症发生率(26.3％比52.0％,x2=4.291,P=0.038)及严重并发症发生率(7.9％比28.0％,x2 =4.565,P=0.033)均明显低,术后住院时间也更短[(14.0±2.6)d比(16.4±4.0)d,t=-2.625,P=0.012].结论 THHVE应用于肝功能受损肝癌患者的肝切除术是安全、有效的,可以明显减少术中出血量、降低输血率、改善术后肝功能恢复、降低并发症的发生率及缩短术后住院时间.
목적 탐토반간혈류완전조단법(THHVE)재간공능수손적간세포암(간칭간암)환자간절제술중적응용개치.방법 회고분석2009년1월지201 1년10월행간절제술적술전유간공능손해적70례간암환자적림상자료.기중행THHVE38례(THHVE조),행Pringle법25례(Pringle법조),미행임하조단7례.THHVE조남성36례,녀성2례,평균년령(54±9)세；Pringle법조남성23례,녀성2례,평균년령(53±10)세.비교량조술중총출혈량、수혈례수、조단시간、병발증발생솔、술후주원시간급술후간공능회복정황.결과 THHVE조여Pringle법조비교술중총출혈량[(317±186) ml비(506±274) ml,t=-3.025,P=0.004]급수요수혈적환자비례(10.5％비32.0％,x2=4.509,P=0.034)균명현저.THHVE조적혈류조단시간요장우Pringle법조[(21±5)min비(17±5)min,t=3.209,P=0.002],단THHVE조술후제3、7천적총담홍소급술후제1、3、7천적ALT균명현저우Pringle법조,술후제7천적전청단백명현고우Pringle법조.THHVE조여Pringle법조비교총병발증발생솔(26.3％비52.0％,x2=4.291,P=0.038)급엄중병발증발생솔(7.9％비28.0％,x2 =4.565,P=0.033)균명현저,술후주원시간야경단[(14.0±2.6)d비(16.4±4.0)d,t=-2.625,P=0.012].결론 THHVE응용우간공능수손간암환자적간절제술시안전、유효적,가이명현감소술중출혈량、강저수혈솔、개선술후간공능회복、강저병발증적발생솔급축단술후주원시간.
Objective To study the clinical value of total hemihepatic vascular exclusion(THHVE) in liver resection for patients with hepatocellular carcinoma (HCC) and impaired liver function.Methods The data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively.THHVE was applied in 38 patients (THHVE group),Pringle maneuver in 25 patients (Pringle group) and no vascular occlusion in 7 patients.In the THHVE group,36 patients were male,2 were female,average age was (54 ± 9) years.And in Pringle group,23 patients were male,2 were female,average age was (53 ± 10) years.Total intraoperative blood loss,blood transfusion rate,clamping time,postoperative complication rate,postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group.Results Total blood loss ((317 ± 186) ml vs.(506 ± 274) ml,t =-3.025,P =0.004) and transfusion rate (10.5％ vs.32.0％,x2 =4.509,P =0.034) were significantly lower in the THHVE group than in the Pringle group.Although the clamping time was longer ((21 ± 5) minutes vs.(17 ± 5) minutes,t =3.209,P =0.002),the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1,3,7 were significantly lower in the THHVE group than in the Pringle group,and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group.Total complication rate (26.3％ vs.52.0％,x2 =4.291,P=0.038) and major complication rate (7.9％ vs.28.0％,x2 =4.565,P=0.033) were lower in the THHVE group than in the Pringle group.And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group ((14.0 ± 2.6) d vs.(16.4 ± 4.0) d,t =-2.625,P =0.012).Conclusions THHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function.It is associated with less blood loss,lower transfusion requirements,better postoperative liver function recovery,lower postoperative complication rate and shorter postoperative hospital stay.