摘要
目的探讨肝门再次阻断法在预防肝切除术后胆漏中的应用价值。方法本前瞻性研究对象为2014年3月至2014年11月在第二军医大学东方肝胆外科医院行单纯肝切除术的197例患者。将患者按随机数字表法分为肝门再次阻断组和传统术式组。其中肝门再次阻断组99例,男81例,女18例;平均年龄(54±11)岁;包括原发性肝癌患者89例,肝脏良性病变患者10例;采用Pringle法切肝后再次阻断第一肝门,使肝内胆管内压力升高,检查并严密缝合胆管。传统术式组98例,男82例,女16例;年龄(52±10)岁;包括原发性肝癌患者91例,肝脏良性病变患者7例;采用Pringle法切肝。患者均签署知情同意书,符合医学伦理学规定。观察并比较两组患者围手术期及预后情况。两组患者肝门阻断时间、手术时间等数据比较采用t检验或Kruskal-Wallis秩和检验,率的比较采用χ2检验或Fisher确切概率法。结果肝门再次阻断组的肝门阻断次数为2(1~4),明显多于传统术式组的1(1~3)(Z=0.000,P<0.05)。肝门再次阻断组的肝门阻断时间为(21±10)min,明显长于传统术式组的(17±9)min(t=0.001,P<0.05)。肝门再次阻断组的术后住院时间为(8±3)d,明显短于传统术式组的(9±3)d(t=-0.040,P<0.05)。肝门再次阻断组术后胆漏发生率为1%(1/99),明显低于传统术式组的9%(9/98)(χ~2=6.830,P<0.05)。胆漏患者经短期引流后,症状均得到有效控制。结论肝门再次阻断法有效降低肝切除术后胆漏的发生率,为外科医师提供一种简单有效的预防胆漏方法。
Objective To investigate the application value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy. Methods In this prospective study, 197 patients who underwent hepatectomy alone in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2014 and November 2014 were recruited. According to the random number talbe method, the patients were divided into the hepatic portal reocclusion group （n=99） and traditional surgery group （n=98）. In the hepatic portal reocclusion group, 81 cases were males and 18 females, aged （54±11） years old on average. Among them, 89 cases were diagnosed with primary liver cancer and 10 with benign liver lesions. After the liver resection with Pringle maneuver, the first porta hepatis was reoccluded to elevate the pressure of intrahepatic blie duct, and the bile duct was examined and tightly sutured. In the traditional surgery group, 82 cases were males and 16 females, aged （52±10） years old on average. Among them, 91 cases were diagnosed with primary liver cancer and 7 with benign liver lesions. The liver resection was performed using Pringle maneuver. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative status and prognosis were observed and compared between two groups. The hepatic portal occlusion time and operation time between two groups were compared using t test or Kruskal-Wallis rank test. The rates were compared using Chi-square test or Fisher＇s exact probability test. Results The frequency of hepatic portal occlusion in the hepatic portal reocclusion group was 2（1-4）, significantly higher than 1（1-3） in the traditional surgery group （Z=0.000, P〈0.05）. The hepatic portal occlusion time in the hepatic portal reocclusion group was （21±10） min, significantly longer than （17±9） min in the traditional surgery group （t=-0.001, P〈0.05）. The postoperative length of hospital stay in the hepatic por
出处
《中华肝脏外科手术学电子杂志》
CAS
2017年第5期353-357,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81272668)
关键词
肝切除术
胆瘘
肝门再次阻断
Hepatectomy
Biliary fistula
Hepatic portal reocclusion
