Calleja Kempín J, Guarnizo Clemente J, Martín Cavanna J, Vázquez Perfecto R, Jiménez Almonacid P, Muro de la Fuente A
Departamento de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid.
Rev Esp Enferm Dig. 1998 Oct;90(10):695-700.
Liver resections over 50% of hepatic volume can be achieved with a low morbi-mortality, although occasionally they are followed by severe complications. Postoperative evolution and complications after this type of hepatic resections with intermittent occlusion of the portal triad have been studied.
13 right hepatectomies, 5 enlarged right hepatectomies and 2 enlarged left hepatectomies were performed consecutively, with intraoperative ultrasound evaluation and intermittent portal triad occlusion.
Maximum time of continuous hepatic hilum occlusion was 15 minutes, with a mean isquemia time of 25 +/- 8.6 minutes. Peak of disturbance of hepatic function was at 24 hours and recovered totally at 7th postoperative day. Nine of the 20 patients (45%) did not need intraoperative transfusion and the average of transfusion was 1.8 +/- 1.9 blood units. Four biliary leaks (20%), with no severe hepatic disfunction were observed during postoperative period, and there was no hospital mortality.
Intermittent portal triad occlusion during hepatic resections in more than 50% of liver volume is a safe surgical maneuver.
超过肝脏体积50%的肝切除术虽偶尔会伴有严重并发症，但可实现较低的病残率和死亡率。已对这类采用门静脉三联体间歇性阻断的肝切除术后的病情演变及并发症进行了研究。
连续实施了13例右半肝切除术、5例扩大右半肝切除术和2例扩大左半肝切除术，术中进行超声评估并采用门静脉三联体间歇性阻断。
肝门连续阻断的最长时间为15分钟，平均缺血时间为25±8.6分钟。肝功能障碍高峰出现在术后24小时，术后第7天完全恢复。20例患者中有9例（45%）术中无需输血，平均输血量为1.8±1.9个单位。术后期间观察到4例胆漏（20%），未出现严重肝功能障碍，且无住院死亡病例。
在超过肝脏体积50%的肝切除术中采用门静脉三联体间歇性阻断是一种安全的手术操作。
