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目的探讨选择性半肝血流完全阻断下切肝术的临床意义。方法回顾性分析第二军医大学东方肝胆外科医院特需治疗科2006-2007年100例因原发性肝癌行不超过半肝的规则性肝切除病人临床资料。其中35例行选择性半肝血流完全阻断切肝术(A组),余65例行全肝入肝血流阻断切肝术(B组),比较两组病人术中肝血流阻断时间、术中出血量、输血量、肝切除体积、术后肝功能恢复情况、并发症发生率等指标。结果A组术中平均出血量及输血病人平均输血量明显少于B组(P<0.05)。在A组肝血流阻断时间明显长于B组(P<0.05)和两组肝切除量差异无统计学意义的情况下,A组术后第3、7d血清前白蛋白水平显著高于B组(P<0.05),而A组术后第1、3、7d血清丙氨酸转氨酶水平均显著低于B组(P<0.01)。术后并发症总发生率为34%,两组并发症发生率差异无统计学意义(P>0.05)。结论选择性半肝血流完全阻断切肝术能显著减少肝切除过程中的出血量并减轻肝功能损害。
Objective To investigate the clinical significance of selective hepatic partial hepatectomy under hepatectomy. Methods The clinical data of 100 cases of regular hepatectomy who did not exceed the hemihepatic liver in 100 cases of primary liver cancer from 2006 to 2007 were retrospectively analyzed in the Department of Special Hepatology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University. Among them, 35 patients underwent selective hepatic partial hepatectomy (group A), and the remaining 65 patients underwent hepatic artery blocking and hepatectomy (group B). The intraoperative hepatic blood flow Blocking time, intraoperative blood loss, blood transfusion, liver resection volume, postoperative recovery of liver function, complication rate and other indicators. Results The mean intraoperative blood loss and blood transfusion in group A were significantly less than those in group B (P <0.05). A group of liver blood flow blocking time was significantly longer than the B group (P <0.05) and the two groups were no significant difference in hepatic resection, A group 3,7 postoperative serum prealbumin levels were significantly higher than B (P <0.05), while the serum alanine aminotransferase levels in group A were significantly lower than those in group B on the 1st, 3rd, 7th day after operation (P <0.01). The overall incidence of postoperative complications was 34%. There was no significant difference in the incidence of complications between the two groups (P> 0.05). Conclusion Selective hepatic partial hepatectomy and hepatectomy can significantly reduce the amount of bleeding during hepatectomy and reduce the impairment of hepatic function.