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目的探讨三种不同肝血流阻断技术在原发性肝癌合并肝硬化手术治疗中的意义。方法回顾性分析因原发性肝癌合并肝硬化行肝切除218例患者的临床资料,其中术中应用Pringle法第一肝门阻断入肝血流65例(A组)、半肝血流阻断76例(B组)、半肝血流阻断加选择性肝静脉控制65例(C组)。比较3组患者肝切除手术时间和术中出血量,术后肝功能恢复以及术后并发症。结果 A、B、C组患者肝切除手术时间分别为(152±18)、(163±21)、(172±23)min,差异无统计学意义(P>0.05);术中出血量分别为(495±76)、(397±64)、(317±65)mL,差异有统计学意义(P<0.01)。在术后2 d和5 d的血清丙氨酸转氨酶[A组:(446±78)U/L与(234±58)U/L;B组:(330±56)U/L与(184±45)U/L;C组:(326±49)U/L与(176±34)U/L]、总胆红素[A组:(56±14)μmol/L与(39±10)μmol/L;B组:(34±10)μmol/L与(23±7)μmol/L;C组:(32±7)μmol/L与(21±9)μmol/L]、前白蛋白[A组:(135±26)mg/L与(166±48)mg/L;B组:(187±35)mg/L与(198±55)mg/L;C组:(196±29)mg/L与(205±41)mg/L]水平比较,B组和C组明显优于A组(P<0.01)。结论针对性左、右半肝血流阻断可防止健侧肝脏缺血再灌注损伤;在手术中选择性肝外控制肝静脉,可显著减少肝切除术中的出血量。
Objective To investigate the significance of three different hepatic blood flow blocking techniques in the surgical treatment of primary liver cancer complicated with cirrhosis. Methods A retrospective analysis of 218 patients with primary hepatocellular carcinoma and liver cirrhosis underwent hepatectomy in clinical data, including the application of Pringle intraoperative hepatic blood flow in the first hilar block 65 cases (group A), hemihepatic resistance Seventy - six patients (group B) and 65 patients with hepatic artery occlusion plus selective hepatic vein control (group C). The operation time, intraoperative blood loss, postoperative liver function recovery and postoperative complications were compared between the three groups. Results The liver resection time was (152 ± 18), (163 ± 21) and (172 ± 23) min in group A, B and C, respectively, with no significant difference (P> 0.05) (495 ± 76), (397 ± 64) and (317 ± 65) mL, respectively. The difference was statistically significant (P <0.01). Serum alanine aminotransferases at 2 and 5 days postoperatively (group A: 446 ± 78 U / L and 234 ± 58 U / L; group B: 330 ± 56 U / L vs 184 ± 45) U / L in group C; (326 ± 49) U / L and (176 ± 34) U / L in group C and total bilirubin in group A (34 ± 10) μmol / L and (23 ± 7) μmol / L in group B; (32 ± 7) μmol / L and (21 ± 9) μmol / L in group C) (Group A: (135 ± 26) mg / L vs (166 ± 48) mg / L; Group B: 187 ± 35 mg / L vs 198 ± 55 mg / 29) mg / L and (205 ± 41) mg / L], the B and C groups were significantly better than the A group (P <0.01). CONCLUSIONS: Targeted left and right hemofluid blockade can prevent ischemia-reperfusion injury in the contralateral liver. Selective extrahepatic control of the hepatic vein during surgery can significantly reduce the amount of bleeding during liver resection.