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目的研究不同肝脏血流阻断方式在半肝切除治疗原发性肝癌中的应用。方法回顾性分析我院2000-2005年行半肝切除治疗原发性肝癌的相关病例资料。A组:行第一肝门阻断(Pringle法)83例;B组:行Pringle法联合肝下下腔静脉阻断67例;C组:解剖性半肝血流(肝动脉、门静脉及肝静脉)阻断32例。结果手术时间C组较A、B组显著延长(t=3．27、t=2．74,均P<0．01),B组术中肝下下腔静脉阻断后中心静脉压(3．99±1．87)cmH2O,较阻断前(8．32±3．56) cmH2O显著下降(t=8．81,P<0．01);出血量(263±146)ml较A组(657±384)ml显著减少(t= 7．94．P<0．01),并且在肝下下腔静脉阻断后没有发生严重的肾脏及循环系统并发症。C组出血量(255±178)ml较A组显著减少(t=5．68,P<0．01),术后第1天A、B组转氨酶比C组显著升高(t= 8．23、8．56,P<0．01)。结论原发性肝癌行半肝切除术中肝下下腔静脉阻断是一种减少出血的安全有效的简便方法,解剖性半肝血流阻断技术要求高,但可避免肝脏缺血再灌注损伤,术中肝损伤也小。
Objective To study the application of different hepatic blood flow blocking methods in the treatment of primary liver cancer by hemihepatectomy. Methods A retrospective analysis of our hospital from 2000 to 2005 hemihepatectomy in the treatment of primary liver cancer related case information. In group A, Pringle method was used in 83 cases. In group B, 67 cases were treated by Pringle method combined with inferior hepatic vena cava vein occlusion. Group C: anatomical hemhepatic blood flow (hepatic artery, portal vein and liver Vein) block in 32 cases. Results The operation time in group C was significantly longer than that in group A and B (t = 3.27, t = 2.74, P <0.01). The central venous pressure .99 ± 1.87) cmH2O, which was significantly lower than that before the interruption (8.32 ± 3.56 cmH2O) (t = 8.81, P <0.01) (657 ± 384) ml was significantly reduced (t = 7.94.P <0.01), and no serious renal and circulatory complications occurred after the inferior hepatic vena cava was occluded. The amount of bleeding in group C (255 ± 178) ml was significantly lower than that in group A (t = 5.68, P <0.01). On the first day after operation, the amount of transaminase in group A and B was significantly higher than that in group C (t = 8. 23, 8.56, P <0.01). Conclusions Hepatic inferior vena cava occlusion during primary hepatectomy is a safe and effective method to reduce hemorrhage. The technique of anatomic hemofluid blockade is high, but it can avoid hepatic ischemia-reperfusion Injury, intraoperative liver damage is also small.