关键词:血流阻断;原发性肝癌;肝切除
摘要 为评价在原发性肝癌(HCC)切除术中应用肝血流阻断方法对术中、术后诸因素的影响以及阻断方法的选择,就近5年来我院收治的163例HCC患者采用不同的肝血流阻断法行肝切除的多项观察指标进行比较,并与同期未加肝门阻断的65例比较。结果:肝血流阻断法虽能控制术中出血,但对肝实质产生损害;第一肝门阻断法简单方便,但阻断时间受限,肝功能损害严重;单侧入肝血流阻断法阻断时间长而术后肝功能损害较轻,恢复快;全肝血流阻断费时复杂,应用受限制。本组资料结果提示:除肝门区和中央型肿瘤外,单侧入肝血流阻断法是理想的肝血流阻断法。
APPLICATION OF HEPATOVASCULAR OCCLUSION INHEPATOCELLULAR CARCINOMA RESECTION
Lai Jiaming, Liang Lijian, Li Dongming.
Department of Hepatobiliary Surgery, First Affiliated Hospital, Zhongshan University of Medical Sciences, Guangzhou 510080
Abstract Selection of andinfluence of several hepatovascular occlusions on intraoperative and postoperative factorswere investigated in a series of hepatocelluar carcinoma (HCC) patients undergoing liverresection. Comparison and statistical analysis of several observation indexes were carriedout in 163 HCC patients experiencing liver resection with different vascular occlusions,versus 65 cases without vascular occlusions, which selected from our hospital during thesame period over the past 5 years. Results: Hepatovascular occlusions produced some liverparenchyma injury, although controlling intraoperative bleeding. In the study, advantagesand disadvantages of three hepatovascular occlusions were demonstrated, including: ①simplicityand convenience in portal triad clamping (PTC); but occlusion time limited and resultingin severe liver function injury ; ②wider liver function injury and quicker recoverydespite longer occlusion in hemihepatic vascular occlusions (HVO); ③limited applicationof normothermic hepatic vascular exclusion (NHVE) for waste-time and complexity . Weconclude that HVO is recommended as the first selection for most liver resection, exceptportal and central tumors.
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