Jiang Hong-Chi, Sun Bei, Zhang Qi
Department of Hepatobiliary and Pancreatic Surgery, the First Clinical College of Harbin Medical University, Harbin 150001, China.
Zhonghua Wai Ke Za Zhi. 2008 Aug 15;46(16):1225-8.
To evaluate the optimal method for hepatic vascular occlusion during resection of liver carcinoma.
One hundred and twenty-four patients with liver carcinoma were divided into four groups of hepatectomy with total hepatic inflow occlusion (group A, 51 cases), selective hepatic inflow occlusion (group B, 38 cases), selective exclusion of hepatic inflow and outflow (group C, 24 cases) and total hemi-hepatic vascular exclusion (group D, 11 cases). The time of operation and hepatic vascular occlusion, intraoperative blood loss and transfusion, postoperative liver function, complications and mortality were compared among the four groups.
There were no significant difference among the four groups statistically in preoperative basic states (P > 0.05). The duration of operation was prolonged significantly in group C and D than that of group A, but intra-operative blood loss and transfusion requirements were decreased significantly in group C and D versus group A and B (P < 0.05). There was no significant difference among the four groups regarding ischemia time, postoperative complications and mortality (P > 0.05). The level of postoperative alanine aminotransferase was higher in group A than other three groups (P < 0.05). The postoperative total bilirubin increased significantly in group A contrast to group B (P < 0.05).
Each hepatic vascular occlusion technique has its place in liver resection. The size and location of tumor, preoperative liver function, underlying liver disease, cardiovascular and cerebral vessels status, and most important the experience and capability to weigh the merits and demerits of the surgeon should be taken into account to select the most appropriate occlusion method.
评估肝癌切除术中肝血管阻断的最佳方法。
124例肝癌患者被分为四组，分别接受全肝血流阻断肝切除术（A组，51例）、选择性肝血流阻断术（B组，38例）、选择性肝血流和流出道阻断术（C组，24例）以及全半肝血管阻断术（D组，11例）。比较四组患者的手术时间、肝血管阻断时间、术中出血量及输血量、术后肝功能、并发症及死亡率。
四组患者术前基本状态差异无统计学意义（P>0.05）。C组和D组的手术时间较A组显著延长，但C组和D组的术中出血量及输血量较A组和B组显著减少（P<0.05）。四组患者的缺血时间、术后并发症及死亡率差异无统计学意义（P>0.05）。A组术后丙氨酸转氨酶水平高于其他三组（P<0.05）。与B组相比，A组术后总胆红素显著升高（P<0.05）。
每种肝血管阻断技术在肝切除术中都有其适用之处。选择最合适的阻断方法时，应考虑肿瘤的大小和位置、术前肝功能、基础肝病、心血管和脑血管状况，最重要的是外科医生权衡利弊的经验和能力。
