CAJ | 학술논문

目的：探讨不解剖肝门的半肝入肝血流阻断(HIO)与全肝入肝血流阻断(TIO)在肝细胞癌患者行肝切除术中的临床应用效果。方法回顾性分析肝细胞癌行肝切除术患者63例,并随机分为两组,HIO组(33例)行不解剖肝门的半肝入肝血流阻断联合控制性低中心静脉压肝切除,TIO组(30例)行全肝入肝血流阻断联合控制性低中心静脉压肝切除。比较两组手术时间、血流阻断时间、术中出血量、术中输血情况,以及术后住院时间、ICU时间、术后第1、3天肝功能。结果两组手术时间、血流阻断时间、术后ICU时间、术中出血量、术中输血情况差异无统计学意义, HIO组术后住院时间显著短于TIO组[(14.1±5.5) d vs (17.2±5.8)d,t=-2.142,P=0.036]；术后第1天HIO组患者血清白蛋白(Alb)水平显著高于TIO组[(34.2±3.5)g/L vs (31.6±3.8)g/L,t=2.784,P=0.007],其余肝功指标(ALT、AST、AKP、GGT、TB、DB)在术后第1天的水平差异无统计学意义,术后第3天两组间肝功指标水平差异无统计学意义。结论两种肝血流阻断技术同样安全、有效,半肝入肝血流阻断在术后住院时间及早期Alb水平恢复上更优。
목적：탐토불해부간문적반간입간혈류조단(HIO)여전간입간혈류조단(TIO)재간세포암환자행간절제술중적림상응용효과。방법회고성분석간세포암행간절제술환자63례,병수궤분위량조,HIO조(33례)행불해부간문적반간입간혈류조단연합공제성저중심정맥압간절제,TIO조(30례)행전간입간혈류조단연합공제성저중심정맥압간절제。비교량조수술시간、혈류조단시간、술중출혈량、술중수혈정황,이급술후주원시간、ICU시간、술후제1、3천간공능。결과량조수술시간、혈류조단시간、술후ICU시간、술중출혈량、술중수혈정황차이무통계학의의, HIO조술후주원시간현저단우TIO조[(14.1±5.5) d vs (17.2±5.8)d,t=-2.142,P=0.036]；술후제1천HIO조환자혈청백단백(Alb)수평현저고우TIO조[(34.2±3.5)g/L vs (31.6±3.8)g/L,t=2.784,P=0.007],기여간공지표(ALT、AST、AKP、GGT、TB、DB)재술후제1천적수평차이무통계학의의,술후제3천량조간간공지표수평차이무통계학의의。결론량충간혈류조단기술동양안전、유효,반간입간혈류조단재술후주원시간급조기Alb수평회복상경우。
Objective To compare the efficacy of half versus total vascular inflow occlusion with-out hilus dissection in hepatocellular carcinoma (HCC) patients undergoing hepatectomy. Methods Sixty-three HCC patients undergoing hepatectomy were divided into two groups: half vascular inflow occlusion group (HIO) and total vascular inflow occlusion group (TIO). There were no hilus dissection and combined controlled low central venous pressure in both groups. Operation time, occlusion time, postoperative hospi-tal stay, postoperative ICU stay, blood loss and transfusion during operation and postoperative day 1 and day 3 liver functions were compared. Results Operation time, occlusion time, postoperative ICU stay, blood loss and transfusion during operation had no significant differences between two groups. Postopera-tive hospital stay was significantly shorter in HIO group [(14.1±5.5) d vs (17.2±5.8) d, t=-2.142, P=0.036]. Postoperative day 1 serum albumin level was significantly higher in HIO group [(34.2±3.5) g/L vs (31.6± 3.8) g/L, t=2.784, P=0.007], while levels of ALT, AST, AKP, GGT, TB, DB had no significant differences between two groups. Postoperative day 3 liver functions had no significant differences between two groups. Conclusion Both occlusion methods are safe and effective, while half vascular inflow occlusion leads to shorter postoperative hospital stay and higher serum albumin level the first day after operation.