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目的累及肝静脉或下腔静脉的肝肿瘤切除最严重的并发症是术中大出血,全肝血流阻断术(THVE)能有效控制术中大出血,但由于阻断下腔静脉,易引起全身血流动力学紊乱。选择性肝血流阻断术(SHVE)仅阻断入肝与出肝血流而保持下腔静脉通畅,不会引起全身血流动力学紊乱。本文就这两种肝血流阻断技术在肝切除术中的应用作一比较。方法2000年1月至2006年6月,共施行包括入肝与出肝血流同时阻断切肝术197例,其中THVE87例,SHVE110例。比较两组病人术前情况、肝切除范围、术中情况、术后并发症等指标。结果所有肿瘤均压迫或侵犯1根以上主肝静脉或下腔静脉,两组病人术前一般情况、肝切除范围、肿瘤病理类型无明显差别,术中出血量、肝热缺血时间、手术时间,THVE组明显高于SHVE组。THVE组有15例同时行下腔静脉癌栓取出术,4例肝静脉癌栓取出术,7例行下腔静脉壁修补术,SHVE组有7例同时行肝静脉取栓术,有1例因肿瘤侵犯下腔静脉壁而改行THVE。术后并发症THVE组明显高于SHVE组,前者有2例术后死于肝功能衰竭,SHVE组无1例死亡。术后ICU时间及住院时间THVE组明显高于SHVE组。结论THVE与SHVE均能有效控制术中肝静脉破裂大出血,THVE对伴有下腔静脉癌栓或静脉壁受侵犯的病人是唯一的选择方法,但THVE对全身血流动力学影响大,对未侵犯下腔静脉而仅侵犯肝静脉的病人更适合采用SHVE。
Purpose The most serious complication of hepatic tumor resection involving the hepatic vein or inferior vena cava is intraoperative hemorrhage. THVE can effectively control intraoperative hemorrhage. However, blocking the inferior vena cava can cause systemic Hemodynamic disorders. Selective hepatic blood flow occlusion (SHVE) only blocks the hepatic and hepatic blood flow while keeping the inferior vena cava free from systemic hemodynamic disturbances. This article compares the two hepatic blood flow blocking techniques in hepatectomy. Methods From January 2000 to June 2006, a total of 197 cases of hepatectomy including hepatic and hepatic blood flow were blocked, including 87 cases of THVE and 110 cases of SHVE. The two groups of patients were compared before surgery, liver resection range, intraoperative situation, postoperative complications and other indicators. Results All the tumors were oppressed or invaded by more than one main hepatic vein or inferior vena cava. There were no significant differences in the general conditions, the range of hepatectomy, the pathological types of the tumor, the intraoperative blood loss, the time of hepatic warm ischemia, the operation time , THVE group was significantly higher than the SHVE group. In the THVE group, 15 patients underwent cuff removal of IVC, 4 patients with hepatic vein tumor thrombus removed, 7 patients underwent IVC repair, 7 patients underwent hepatic vein thrombectomy in SHVE group and 1 patient Due to tumor invasion of the inferior vena cava wall diverted THVE. Postoperative complications were significantly higher in the THVE group than in the SHVE group, with 2 cases of postoperative death from liver failure and 1 case of death in the SHVE group. Postoperative ICU time and hospital stay in THVE group was significantly higher than SHVE group. Conclusions Both THVE and SHVE can effectively control intrahepatic hepatic vein rupture and haemorrhage. THVE is the only choice for patients with IVC thrombus or venous wall invasion, but THVE has a great effect on systemic hemodynamics. Invaded the inferior vena cava and only violated the hepatic vein in patients with SHVE is more suitable.