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目的:观察半肝血流完全阻断对肝癌左半肝切除的效果。方法:选择行左半肝切除术肝癌患者72例,随机分观察组35例和对照组37例。观察组采用半肝血流完全阻断,对照组采用肝门血流阻断。比较两组肝血流阻断时间,术中出血量,术前及术后1天、3天、7天血清前清蛋白、谷丙转氨酶(ALT)和血清胆碱酯酶水平变化,术后1年肿瘤复发率及无瘤生存时间等。结果:两组血流阻断时间和术中出血量差异不显著(P>0.05)。术前两组血清前清蛋白、ALT和血清胆碱酯酶水平差异不显著(P>0.05);观察组术后1天、3天和7天ALT水平显著低于对照组相同时间节点(P<0.05),血清前清蛋白和血清胆碱酯酶水平显著高于对照组相同时间节点(P<0.05)。观察组术后1年复发率28.6%,显著低于对照组的术后1年复发率37.8%(P<0.05);观察组中位无瘤生存时间26.4个月,显著长于对照组的20.1个月(P<0.05)。结论:行左半肝切除术时,采用半肝血流完全阻断效果优于肝门血流阻断。
Objective: To observe the effect of complete occlusion of hemihepatic blood flow on the left hepatectomy of liver cancer. Methods: Seventy - two patients with HCC who underwent left hepatectomy were randomly divided into observation group (35 cases) and control group (37 cases). The observation group was completely blocked by hemihepatic blood flow, and the control group was blocked by hepatic portal blood flow. The changes of hepatic blood flow occlusion time, intraoperative blood loss, serum prealbumin, alanine aminotransferase (ALT) and serum cholinesterase levels in the two groups were compared before and after operation for 1 day, 3 days and 7 days. 1 year tumor recurrence rate and tumor-free survival time. Results: There was no significant difference between the two groups in blood flow blocking time and intraoperative blood loss (P> 0.05). The levels of serum prealbumin, ALT and serum cholinesterase in the two groups before surgery were not significantly different (P> 0.05). The levels of ALT in the observation group at 1 day, 3 days and 7 days after operation were significantly lower than those in the control group at the same time point <0.05), serum prealbumin and serum cholinesterase levels were significantly higher than the control group at the same time point (P <0.05). In the observation group, the recurrence rate was 28.6% at 1 year after operation and significantly lower than that at 1 year after operation in the control group (37.8%, P <0.05). The median tumor-free survival time in the observation group was 26.4 months, significantly longer than that in the control group Month (P <0.05). Conclusion: When the left hemihepatectomy is performed, the complete blocking effect of hemihepatic blood flow is better than that of hepatic portal blood flow.