对慢性肝病患者在原位肝脏简单降温后进行持续入肝血流阻断下的101例肝切除术。

101 hepatectomies under continuous inflow occlusion following simple in-situ liver cooling in patients with chronic liver diseases.

作者信息

Kim Yang-Il, Hwang Yoon-Jin, Lee Jong-Won, Chun Byung-Yeol, Kawano Katsunori, Kitano Seigo

机构信息

Department of Surgery, Biomolecular Engineering Center, Liver Research Institute Kyungpook National University, School of Medicine, Taegu, Korea.

出版信息

Hepatogastroenterology. 2004 Jul-Aug;51(58):1093-8.

PMID:15239253

Abstract

BACKGROUND/AIMS: Hepatic inflow occlusion involves the serious disadvantage of ischemic injury to the remnant liver, particularly in patients with injured parenchyma. Liver hypothermia is one of the solutions for this problem. The purpose of this study was to evaluate simple in-situ liver cooling method of performing hepatic resection under continuous inflow occlusion in patients with chronic liver disease.

METHODOLOGY

One hundred and one patients with chronic hepatitis (n = 26) and cirrhosis (n = 75) were included in this retrospective study. They underwent hepatectomy under conditions of continuous inflow occlusion immediately following simple in-situ liver cooling. Laboratory data and intraoperative and postoperative variables were analyzed for the three groups of patients stratified according to the lowest liver tissue temperature achieved: group 1 (> or = 30 degrees C, n = 16), group 2 (< 30 degrees C and > or = 25 degrees C, n = 62) and group 3 (< 25 degrees C, n = 20).

RESULTS

Our simple in-situ liver cooling method enabled us to safely resect chronically diseased liver under continuous inflow occlusion (49.8 +/- 7.7 min, mean +/- SD; range, 30 to 70 min) with acceptable operative blood loss (894 +/- 853mL), morbidity (22.7%, 23/101) and mortality (1.0%, 1/101); one patient died of complications unrelated to ischemic injury. Analysis demonstrated that simple liver hypothermia was substantially hepatoprotective against ischemic injury in terms of serum transaminase levels and duration of inflow occlusion, particularly when the liver tissue temperature fell below 30 degrees C (groups 2 and 3).

CONCLUSIONS

Hepatic inflow occlusion can be safely employed in a continuous manner for approximately 1 hour, even during resection of chronically diseased liver, particularly when the liver is cooled below 30 degrees C prior to hepatic clamping by our simple in-situ hypothermia technique.

摘要

背景/目的：肝血流阻断存在对残余肝造成缺血性损伤的严重缺点，尤其是对于肝实质受损的患者。肝脏低温是解决这一问题的方法之一。本研究的目的是评估在慢性肝病患者中，在持续血流阻断下采用简单的原位肝脏降温方法进行肝切除的效果。

方法

本回顾性研究纳入了101例慢性肝炎患者（n = 26）和肝硬化患者（n = 75）。他们在简单的原位肝脏降温后立即在持续血流阻断的条件下接受肝切除术。根据所达到的最低肝组织温度对三组患者的实验室数据以及术中、术后变量进行分析：第1组（≥30℃，n = 16），第2组（<30℃且≥25℃，n = 62）和第3组（<25℃，n = 20）。

结果

我们的简单原位肝脏降温方法使我们能够在持续血流阻断下（49.8±7.7分钟，平均值±标准差；范围，30至70分钟）安全地切除慢性病变肝脏，术中失血可接受（894±853mL），发病率为22.7%（23/101），死亡率为1.0%（1/101）；1例患者死于与缺血性损伤无关的并发症。分析表明，就血清转氨酶水平和血流阻断持续时间而言，简单的肝脏低温对缺血性损伤具有显著的肝脏保护作用，尤其是当肝组织温度降至30℃以下时（第2组和第3组）。