慢性肝病患者肝切除术中，采用原位及肝脏表面降温并延长入肝血流阻断时间。
In situ and surface liver cooling with prolonged inflow occlusion during hepatectomy in patients with chronic liver disease.
作者信息
Kim Y I, Kobayashi M, Nakashima K, Aramaki M, Yoshida T, Mitarai Y
机构信息
Department of Surgery I, Oita Medical University, Japan.
出版信息
Arch Surg. 1994 Jun;129(6):620-4. doi: 10.1001/archsurg.1994.01420300062009.
OBJECTIVE
We examined in situ and surface liver hypothermia with continuous and prolonged inflow occlusion during hepatic resection (segmentectomy or subsegmentectomy).
PARTICIPANTS
Eight patients with cirrhosis and three with chronic hepatitis.
METHODS
In situ chilling was achieved by introducing cold Ringer's lactate solution through the portal vein, under conditions of portal triad occlusion.
RESULTS
The liver tissue temperature fell to a mean of 28.4 degrees C 5 minutes later. The time of ischemia ranged from 32 to 52 minutes (mean +/- SD, 47.8 +/- 5.6 minutes). The mean blood loss was significantly lower than in our conventional hepatectomy series (680 vs 1520 mL, P < .02).
MAIN OUTCOME
There were no serious complications, and hypoxia-induced liver injury was ameliorated, as shown by liver function tests.
CONCLUSION
Hepatectomy with prolonged inflow occlusion is justified in low-risk patients with chronic liver disease if it is combined with liver hypothermia, such as simple in situ and surface cooling.
目的
我们在肝切除（肝段切除术或亚肝段切除术）期间，采用持续和延长的入肝血流阻断，对肝脏原位低温和表面低温进行了研究。
参与者
8例肝硬化患者和3例慢性肝炎患者。
方法
在门静脉三联管阻断的条件下，通过门静脉注入冷乳酸林格液实现原位低温。
结果
5分钟后肝组织温度平均降至28.4摄氏度。缺血时间为32至52分钟（平均±标准差，47.8±5.6分钟）。平均失血量显著低于我们传统肝切除系列（680 vs 1520 mL，P <.02）。
主要结果
未出现严重并发症，肝功能检查显示缺氧性肝损伤得到改善。
结论
对于慢性肝病低风险患者，如果肝切除联合肝脏低温，如单纯原位和表面降温，延长入肝血流阻断是合理的。
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