目的:探讨半肝血流阻断联合肝静脉阻断技术在精准肝切除中的应用价值。方法:回顾性分析我科2013年1月至2014年12月共120例行半肝血流阻断联合肝静脉阻断的精准肝切除病例,作为治疗组。另选单用第一肝门阻断的复杂肝癌半肝切除患者318例...目的:探讨半肝血流阻断联合肝静脉阻断技术在精准肝切除中的应用价值。方法:回顾性分析我科2013年1月至2014年12月共120例行半肝血流阻断联合肝静脉阻断的精准肝切除病例,作为治疗组。另选单用第一肝门阻断的复杂肝癌半肝切除患者318例为对照。结果:治疗组在控制术中出血和输血量方面优于单用半肝血流阻断的对照组,治疗组术中平均出血量为650±46 m L,平均输血量为410±76 m L,差别有统计学意义(P<0.05);治疗组在平均手术时间和平均住院时间方面均少于对照组,但两组差别无统计学意义(P>0.05)。结论:半肝血流阻断联合肝静脉阻断技术在复杂肝癌的精准肝切除术中合理使用能有效的减少术中出血,提高了手术安全,降低了术中输血量,最大限度保留剩余肝细胞体积,减少了缺血再灌注的损失。展开更多
目的比较入肝血流阻断与不阻断在原发性肝癌切除术中围手术期的有效性、安全性。方法回顾性分析重庆医科大学附属第二医院肝胆外科2015年1月至2018年1月收治的45例接受肝切除术的原发性肝癌(局限于半肝)患者的临床资料,其中间歇性第一...目的比较入肝血流阻断与不阻断在原发性肝癌切除术中围手术期的有效性、安全性。方法回顾性分析重庆医科大学附属第二医院肝胆外科2015年1月至2018年1月收治的45例接受肝切除术的原发性肝癌(局限于半肝)患者的临床资料,其中间歇性第一肝门阻断者19例为A组,半肝血流阻断者10例为B组,不阻断入肝血流者16例为C组。比较三组患者术中失血量、手术时间、术后肝功能损伤水平[白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(Tbil)、凝血酶原时间(PT)]等。结果 B组与C组比较,其术中失血量[(795.0±463.4) mL vs (343.8±361.3) m L]明显增多,而A组、B组较C组手术时间[(230.5±52.7) min vs (241.5±64.1)min vs (190.6±52.6) min]均明显延长,差异均有统计学意义(P<0.05);在术后第1天,A组、B组和C组的Alb [(33.8±3.7) g/L vs (32.6±4.1)g/L vs (36.8±3.1) g/L]水平比较,A组、B组均明显低于C组,而Tbil[(28.1±10.2)μmol/L vs(28.6±12.8)μmol/L vs (17.2±6.7)μmol/L]、AST[(454.1±256.7) U/L vs (421.4±265.3) U/L vs (229.5±152.1) U/L]水平比较,A组、B组均明显高于C组,差异均有统计学意义(P<0.05);在术后第3天,A组和C组的Tbil[(28.3±13.8)μmol/Lvs (19.7±8.2)μmol/L]、ALT[(278.7±198.8) U/L vs (145.0±98.6) U/L]、AST[(196.7±135.2) U/L vs (89.2±83.2) U/L]、PT[(15.9±1.4) s vs (14.6±1.1) s]水平比较,A组明显高于C组,而B组的Alb为(31.5±3.5) g/L,明显低于C组的(34.7±3.1) g/L,差异均有统计学意义(P<0.05);在术后第7天,A组和C组的AST[(57.7±16.4) U/L vs (39.6±15.8) U/L]、PT[(14.9±0.9) s vs (14.2±0.6) s]水平比较,A组明显高于C组,而B组和C组的Alb[(29.6±10.4) g/L vs (35.5±3.5) g/L]水平比较,B组明显低于C组,差异均有统计学意义(P<0.05);A组术后住院时间为(14.9±0.9) d,明显长于C组的(12.2±2.8) d,差异有统计学意义(P<0.05)。结论与血流阻断组比较,采用不阻断入肝血流的肝癌切除术同样安全可行展开更多
AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were ...AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion:group 1,vascular occlusion was achieved by the Pringle maneuver (n=20);group 2,by hemihepatic vascular occlusion (HVO) (n=20);and group 3,by BIOwHAC (n=19).We compared the procedures among the three groups in term of operation time,intraoperative bleeding,postoperative liver function,postoperative complications,and length of hospital stay.RESULTS:There were no statistically significant differences (P > 0.05) in age,sex,pathological diagnosis,preoperative Child's disease grade,hepatic function,and tumor size among the three groups.No intraoperative complications or deaths occurrred,and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding,hepatic function change 3 and 7 d after operation,the incidence of complications,and length of hospital stay.BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO;the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).CONCLUSION:BIOwHAC is convenient and safe;this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.展开更多
Background The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood in...Background The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma （HCC） resection. Methods Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion （with/without hemihepatic artery control） and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I （Pringle maneuver）, 98 in group II （hepatic blood inflow occlusion）, and 76 in group III （hepatic blood inflow occlusion without hemihepatic artery control）. The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation. Results The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and Ill postoperation than those in group I. Conclusion Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.展开更多
文摘目的:探讨半肝血流阻断联合肝静脉阻断技术在精准肝切除中的应用价值。方法:回顾性分析我科2013年1月至2014年12月共120例行半肝血流阻断联合肝静脉阻断的精准肝切除病例,作为治疗组。另选单用第一肝门阻断的复杂肝癌半肝切除患者318例为对照。结果:治疗组在控制术中出血和输血量方面优于单用半肝血流阻断的对照组,治疗组术中平均出血量为650±46 m L,平均输血量为410±76 m L,差别有统计学意义(P<0.05);治疗组在平均手术时间和平均住院时间方面均少于对照组,但两组差别无统计学意义(P>0.05)。结论:半肝血流阻断联合肝静脉阻断技术在复杂肝癌的精准肝切除术中合理使用能有效的减少术中出血,提高了手术安全,降低了术中输血量,最大限度保留剩余肝细胞体积,减少了缺血再灌注的损失。
文摘目的比较入肝血流阻断与不阻断在原发性肝癌切除术中围手术期的有效性、安全性。方法回顾性分析重庆医科大学附属第二医院肝胆外科2015年1月至2018年1月收治的45例接受肝切除术的原发性肝癌(局限于半肝)患者的临床资料,其中间歇性第一肝门阻断者19例为A组,半肝血流阻断者10例为B组,不阻断入肝血流者16例为C组。比较三组患者术中失血量、手术时间、术后肝功能损伤水平[白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(Tbil)、凝血酶原时间(PT)]等。结果 B组与C组比较,其术中失血量[(795.0±463.4) mL vs (343.8±361.3) m L]明显增多,而A组、B组较C组手术时间[(230.5±52.7) min vs (241.5±64.1)min vs (190.6±52.6) min]均明显延长,差异均有统计学意义(P<0.05);在术后第1天,A组、B组和C组的Alb [(33.8±3.7) g/L vs (32.6±4.1)g/L vs (36.8±3.1) g/L]水平比较,A组、B组均明显低于C组,而Tbil[(28.1±10.2)μmol/L vs(28.6±12.8)μmol/L vs (17.2±6.7)μmol/L]、AST[(454.1±256.7) U/L vs (421.4±265.3) U/L vs (229.5±152.1) U/L]水平比较,A组、B组均明显高于C组,差异均有统计学意义(P<0.05);在术后第3天,A组和C组的Tbil[(28.3±13.8)μmol/Lvs (19.7±8.2)μmol/L]、ALT[(278.7±198.8) U/L vs (145.0±98.6) U/L]、AST[(196.7±135.2) U/L vs (89.2±83.2) U/L]、PT[(15.9±1.4) s vs (14.6±1.1) s]水平比较,A组明显高于C组,而B组的Alb为(31.5±3.5) g/L,明显低于C组的(34.7±3.1) g/L,差异均有统计学意义(P<0.05);在术后第7天,A组和C组的AST[(57.7±16.4) U/L vs (39.6±15.8) U/L]、PT[(14.9±0.9) s vs (14.2±0.6) s]水平比较,A组明显高于C组,而B组和C组的Alb[(29.6±10.4) g/L vs (35.5±3.5) g/L]水平比较,B组明显低于C组,差异均有统计学意义(P<0.05);A组术后住院时间为(14.9±0.9) d,明显长于C组的(12.2±2.8) d,差异有统计学意义(P<0.05)。结论与血流阻断组比较,采用不阻断入肝血流的肝癌切除术同样安全可行
基金Supported by The Inner Mongolia Science Foundation,Grant No.2009BS1103
文摘AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion:group 1,vascular occlusion was achieved by the Pringle maneuver (n=20);group 2,by hemihepatic vascular occlusion (HVO) (n=20);and group 3,by BIOwHAC (n=19).We compared the procedures among the three groups in term of operation time,intraoperative bleeding,postoperative liver function,postoperative complications,and length of hospital stay.RESULTS:There were no statistically significant differences (P > 0.05) in age,sex,pathological diagnosis,preoperative Child's disease grade,hepatic function,and tumor size among the three groups.No intraoperative complications or deaths occurrred,and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding,hepatic function change 3 and 7 d after operation,the incidence of complications,and length of hospital stay.BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO;the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).CONCLUSION:BIOwHAC is convenient and safe;this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.
文摘Background The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma （HCC） resection. Methods Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion （with/without hemihepatic artery control） and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I （Pringle maneuver）, 98 in group II （hepatic blood inflow occlusion）, and 76 in group III （hepatic blood inflow occlusion without hemihepatic artery control）. The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation. Results The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and Ill postoperation than those in group I. Conclusion Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.
