Elias D, Desruennes E, Lasser P
Department of Digestive Oncologic Surgery, Institute Gustave-Roussy, Villejuif, France.
Br J Surg. 1991 Jan;78(1):42-4. doi: 10.1002/bjs.1800780115.
From 112 consecutive hepatectomies for malignant tumours performed with intermittent portal triad clamping, we have retrospectively selected the 20 cases in which clamping exceeded 90 min. Intermittent portal clamping of prolonged duration was used because of abnormal liver texture in 13 cases (mainly patients who had received intra-arterial chemotherapy) and/or because of technically difficult hepatectomy. The mean(s.d.) duration of intermittent portal clamping was 109(18) min and in two cases it exceeded 140 min (148 and 150 min). There was no postoperative mortality and the rate of postoperative morbidity was 35 per cent. Postoperative changes in biochemical liver tests were not major and transient hepatic failure occurred in only one patient following subtotal resection of the liver. We conclude that intermittent portal clamping is a useful manoeuvre in partial hepatectomy when resection is difficult or prolonged, or when the liver parenchyma is abnormal. Such clamping may be used for longer than 120 min without major complications.
在112例采用间歇性门静脉三联阻断法进行的恶性肿瘤肝切除术中，我们回顾性选取了20例阻断时间超过90分钟的病例。13例（主要是接受过动脉内化疗的患者）因肝脏质地异常和/或肝切除技术困难而采用了长时间的间歇性门静脉阻断。间歇性门静脉阻断的平均（标准差）时间为109（18）分钟，2例超过140分钟（148和150分钟）。术后无死亡病例，术后发病率为35%。肝脏生化检查的术后变化不显著，仅1例患者在肝次全切除术后发生短暂性肝衰竭。我们得出结论，当肝切除困难或时间延长，或肝实质异常时，间歇性门静脉阻断在肝部分切除术中是一种有用的操作。这种阻断可使用超过120分钟而无严重并发症。
