摘要
目的:探讨三种不同的肝血流阻断方法用于腹腔镜肝部分切除术的安全性及有效性,为肝胆外科手术提供参考。方法:对我院2011年7月至2013年9月收治的83例肝脏肿瘤行肝部分切除术患者的临床资料进行分析。根据肝血流阻断方式,将所选病例分为三组:间歇性断流组(22例),完全断流组(28例),选择性断流组(33例)。观察并比较三组患者的手术时间、断流时间、术中出血量、输血量、术后肝功能指标的变化及并发症的发生率。结果:三组的平均手术时间和断流时间无显著差异(P>0.05);选择性肝血流阻断组患者的术中出血量和输血量均显著少于间歇性断流组和完全断流组(P<0.05);三种断流方式术后均发生并发症,但选择性阻断术后并发症的发生率明显低于间歇性断流和完全断流术,差异具有统计学意义(P<0.05)。三组患者术后的血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)的水平均呈现不同程度降低,血清白蛋白(ALB)的含量升高;选择性断流组各指标变化更明显,数值更接近于正常水平(P<0.05)。结论:与传统断流方法比,选择性肝血流阻断法能够减少剩余肝脏的再灌注损伤,有利于提高手术效果。但该方法存在一定局限,应根据患者实际情况选择断流方式。
Objective： To discuss the clinical effects of different methods of hepatic vascular exclusion for the hepatectomy and to analyze the influence on liver functions in order to make a reference. Methods： A retrospective analysis was performed about the clinical data of 83 patients with liver cancer who were accepted the partial hepatectomy in our hospital from July 2011 to September 2013. According to the different exclusion methods, the selected patients were divided into three groups. The IHVE group（22 cases）, the THVE group （28 cases） and the SHVE group （33 cases）. The operation time, the exclusion time, the blood loss, the transfusion volume, the incidence of complications and the liver function index of patients before and after the operation were observed and analyzed. Results： There was no statistically significant difference about the operation time and the exclusion time （P〉0.05）. The blood loss and transfusion volume of patients in the SHVE group were lower than those of the THVE group and the IHVE group with statistically significant differences（P〈0.05）. The incidence of complications in the SHVE group was lower than those of the other two groups（P〉0.05）. The liver function index of patients in the SHVE group was statistically significant better than those of others with the AST, ALT and TBIL decreasing, and ALB increasing after the partial hepatectomy （P〈0.05）. Conclusions： It is suggested that the selected hepatic vascular exclusion could reduce the postoperative complications and the ischemic reperfusion damage to the residual liver tissues so as to improve the clinical effects. However, it is indicated that we should take the proper decision on the basis of the specific conditions of patients.
出处
《现代生物医学进展》
CAS
2014年第16期3106-3108,3122,共4页
Progress in Modern Biomedicine
基金
北京市科技计划首都临床特色应用研究专项(Z131100004013041)
