摘要
目的探讨腹腔镜肝切除术中3种肝门阻断方式的手术效果。方法回顾性分析应用3种不同的肝门阻断方式的41例腹腔镜肝切除术患者的临床资料，其中15例应用Pringle法，即间歇肝门阻断法（IPO法），12例应用半肝血流阻断法（HVO法），即阻断一侧的（肿瘤侧）门静脉及肝动脉。14例应用选择性半肝血流阻断法（SVO法），即阻断门静脉和肿瘤侧的肝动脉。对术中出血量、手术时间、中转开腹率、术后肝功能、住院时间及并发症发生情况进行统计学分析，比较不同阻断方式间的差异。结果41例患者手术均获得成功，无死亡及中转开腹。IPO、HVO、SVO三组术中出血分别为（218．4±43．5）mL、（289．5±54．5）mL、（231．1±53．7）mL，差异无统计学意义（P〉0．05）；手术时间分别为（161．3±26．5）min、（179．1±33．4）min、（170．5±23．8）min，差异无统计学意义（P〉0．05）；肝门阻断时间分别为（34．3±13．5）min、（45．6±18．6）min、（36．6±14．2）min、差异无统计学意义（P〉0．05）；平均住院时间为（14．7±5．3）d、（11．2±3．4）d、（12．1±2．9）d，差异无统计学意义（P〉0．05）。三组共10例患者发生术后并发症，均治愈。HVO和SVO组的术后肝功能恢复无差异，但均较IPO组更快。结论选择性的肝门阻断在腹腔镜肝切除中是安全可行的，HVO法适用于左半肝或肝左外叶的切除，而SVO法适用于肝右叶肿瘤的切除。
Objective To investigate the intra-and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pediele occlusion （IPO）, hemihepatic vascular occlusion （HVO）, and selective vascular occlusion（SVO）. Methods Retrospective analysis the data of 41 cases of laparoscopic liver resection were conducted in three groups of patients under different occlusion methods, including 15 cases of intermittent total pedicle occlusion （ IPO）, 12 cases of hemihepatie vascular occlusion （HVO） and 14 cases of selective vascular oc- clusion （SVO）. Intraoperation blood loss, operation time, conversion to open operation, changes in postoperative liver function, hospital stays and complications were compared among the three methods. Results There was no operative death in any of the 41 patients. There was no conversion to open surgery. Generally, there was no signifi- cant difference among the three groups in blood loss, clamping time or operative time. Ten patients had postopera- tive complication and all were cured. The effect on liver function for Gro-HVO and Gro-SVO was significantly less severe than that for Gro- IPO （P 〈 0.05 ） after operation. Conclusions Both HVO and SVO are feasible and safe in laparoscopic hepatectomy （LH）, and have advantage in reducing liver remnant ischemia injury and modality rate over IPO. HVO is easy to do for left lateral lobe or resection of the left half of the liver. SVO is suitable for fight lobe resection.
出处
《国际外科学杂志》
2013年第4期252-254,F0004,共4页
International Journal of Surgery
关键词
腹腔镜
肝切除术
肝门阻断
肝肿瘤
Laparoscopic
Hepatotectomy
Blood flow occlusion
Liver neoplasms
