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[使用不同解剖方法切除肝脏前后肝脏的功能状态]

[Functional state of liver before and after its resection using various dissection methods].

作者信息

Skoryĭ D I

出版信息

Klin Khir. 2012 Sep(9):17-21.

Abstract

Today a few randomized investigations have been accomplished, in which advantages and disadvantages of various methods of hepatic resection are compared. The investigation objective was to estimate the hepatic functional state before and after its resection, using various methods of parenchymal dissection. Randomized investigation was conducted in 90 patients, to whom hepatic resection, using scalpel, with its preliminary suturing by the block-like sutures with the Vycril thread, applying radiofrequency coagulator, "clamp crushing" procedure, ultrasonic (Sonoca 300) and a water-jet (Hydrojet) dissectors. The dissection was not combined with the hepatic vessels exclusion. Coefficient of elimination of indocyangreen and a speciphic coefficient of its elimination were estimated. There was established, that putting the block-like sutures and radiofrequency coagulation, concerning the hermetization peculiarities, causes the resection area ischemia, what is accompanied by persisting degradation of hepatocytes and hepatic functional reserve reduction as a result of its resection performance. While the extended hepatic resection conduction it is expedient to apply the methods of ultrasonographic, the jet-like dissection or a "clamp crushing", which guarantee minimization of risk of postoperative hepatic insufficiency occurrence.

摘要

如今已完成了一些随机研究,其中比较了各种肝切除方法的优缺点。研究目的是使用各种实质分离方法评估肝切除前后的肝功能状态。对90例患者进行了随机研究,这些患者接受了使用手术刀进行肝切除,并先用维克利丝线进行块状缝合、应用射频凝固器、“钳夹挤压”操作、超声(Sonoca 300)和水刀(Hydrojet)分离器。分离过程未结合肝血管阻断。评估了吲哚菁绿清除系数及其特异性清除系数。结果表明,就封闭特性而言,进行块状缝合和射频凝固会导致切除区域缺血,这会伴随着肝细胞持续退化以及由于切除操作导致肝功能储备降低。在进行扩大肝切除时,宜采用超声、喷射状分离或“钳夹挤压”方法,这些方法可确保将术后肝衰竭发生的风险降至最低。

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