摘要
目的探讨选择性阻断或结扎患侧肝动脉、门静脉干、及患侧肝静脉并在肝后隧道置阻断带联合阻断进行肝切除术的效果。方法自2007年3月至2008年2月，对14例肝肿瘤患者采取预先将患侧肝动脉、门静脉和肝静脉阻断或结扎并在肝后下腔静脉隧道置阻断带联合阻断下完成肝切除术。结果全组14例患者在分离肝右静脉过程发生小破裂口2例，缝合后出血停止。本组患者无下腔静脉或肝短静脉意外损伤。在切肝过程中出血最少100ml，最多600ml，平均出血量280ml。并发少量胸腔积液4例，1例通过胸穿抽液治愈，其余3例自行吸收。无肝功能严重损害、胆瘘和腹腔感染以及其他并发症。结论预先进行患侧肝动脉、门静脉干、及肝静脉阻断或结扎方法以及利用肝后隧道放置阻断带联合阻断下进行肝切除术可以减少术中出血、及对侧肝再灌注损伤。
Objective To evaluate ipsilaterat hepatic blood flow exclusion in combination with liver hanging manoeuvre for hepatectomy. Methods From Jul 2007 to Feb 2008, 14 cases underwent hemihepatectomy under ipsilateral hepatic blood inflow and draining hepatic vein exclusion in combination with liver hanging manoeuvre for liver malignancier or ligating ligating vessels, portal vein branch and major hepatic vein to set up a tunnel at the interior vena cava. Results Small laceration on right hepatic vein was encountered in 2 cases during the operation and managed by suturing. There was no intraoperative injury on inferior vena cava or short hepatic veins. Blood loss ranged from 100 ml to 600 ml with a mean of 280 ml. Postoperative pleural effusion was cured conservatively in 3 cases and paracentes was needed in one case. There was no severe postoperative hepatorenal dysfunction, biliary fistula, infection or other major complications. The operative mortality was nil. Conclusion For regular major hepateetomy, ipsilateral hepatic blood flow exclusion plus liver hanging manoeuvre has the advantage of less blood loss and protecting contralateral hemiliver from reperfusion injuries.
出处
《中华普通外科杂志》
CSCD
北大核心
2008年第11期839-842,共4页
Chinese Journal of General Surgery
关键词
肝肿痛
肝切除术
血管阻断
Liver neoplasms
Hepatectomy
Vascular occlusion
