中华肝脏外科手术学电子杂志Issue(6)：31-34,4.DOI:10.3877/cma.j.issn.2095-3232.2014.06.007
保留半肝动脉血流的肝门阻断在肝细胞癌肝切除术中的应用
Use of hepatic portal occlusion without hemihepatic artery control in liver resection for hepatocelluar carcinoma
摘要
Abstract
ObjectiveTo investigate the value of hepatic portal occlusion without hemihepatic artery control (hemihepatic occlusion) in liver resection for hepatocelluar carcinoma (HCC).Methods Clinical data of 422 patients with HCC undergoing liver resection in Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University from January 2007 to January 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into two groups according to the different hepatic inlfow occlusions:the hemihepatic occlusion group (n=140) and Pringle maneuver group (n=282). There were 114 males and 26 females in the hemihepatic occlusion group with a mean of (45±12) years old. Hemihepatic occlusion was performed in this group and the hepatic arterial branch of the healthy side was dissected up along the proper hepatic artery. The other hepatic pedicles including hepatic artery of the diseased side, hepatic portal vein and bile duct were occluded with occluding straps. There were 230 males and 52 females in the Pringle maneuver group with a mean of (47±13) years old and Pringle maneuver was performed. The differences were compared between two groups in the operation time, occlusion time, intraoperative blood loss, peak levels of blood alanine aminotransferase (ALT), total bilirubin (TB) within 5 days after operation and incidence of postoperative complications. The variation of patient quantity in the periods of 2007-2009 and 2010-2013 in two groups was observed. The data between two groups were compared byt test and the comparison of ratio was conducted by Chi-square test.ResultsThe peak levels of blood ALT, TB within 5 days after operation were (179±53) U/L, (24±9) μmol/L in hemihepatic occlusion group and were (291±126) U/L, (30±15) μmol/L in Pringle maneuver group accordingly, where signiifcant differences were observed (t=-12.757,-5.777;P<0.05). There was no signiifcant difference in the operation time, occlusion time, intraoperative blood loss and incidence of postoperative complications between two groups (P>0.05). From the year 2007 to 2009, the patients undergoing hemihepatic occlusion accounted for 24.2% (53/219) and increased to 42.9% (87/203) during the year 2010-2013. From the year 2007 to 2009, the patients undergoing Pringle maneuver accounted for 75.8% (166/219) and decreased to 57.1% (116/203) during the year 2010-2013. Signiifcant difference was observed in the variation of patient quantity between two groups (χ2=16.540,P<0.05).ConclusionsCompared with the Pringle maneuver, the hepatic portal occlusion without hemihepatic artery control causes lighter liver damage after liver resection in patients with HCC and it has been gradually widely used in clinic in recent years.关键词
癌,肝细胞/肝切除术/半肝血流阻断/肝动脉Key words
Carcinoma, hepatocelluar/Hepatectomy/Hemihepatic vascular occlusion/Hepatic artery引用本文复制引用
李川江,邹衍泰,林建华,方学军,崔忠林,周杰..保留半肝动脉血流的肝门阻断在肝细胞癌肝切除术中的应用[J].中华肝脏外科手术学电子杂志,2014,(6):31-34,4.基金项目
南方医院院长基金 （）
