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目的:探讨三种不同的肝血流阻断方法用于腹腔镜肝部分切除术的安全性及有效性,为肝胆外科手术提供参考。方法:对我院2011年7月至2013年9月收治的83例肝脏肿瘤行肝部分切除术患者的临床资料进行分析。根据肝血流阻断方式,将所选病例分为三组:间歇性断流组(22例),完全断流组(28例),选择性断流组(33例)。观察并比较三组患者的手术时间、断流时间、术中出血量、输血量、术后肝功能指标的变化及并发症的发生率。结果:三组的平均手术时间和断流时间无显著差异(P>0.05);选择性肝血流阻断组患者的术中出血量和输血量均显著少于间歇性断流组和完全断流组(P<0.05);三种断流方式术后均发生并发症,但选择性阻断术后并发症的发生率明显低于间歇性断流和完全断流术,差异具有统计学意义(P<0.05)。三组患者术后的血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)的水平均呈现不同程度降低,血清白蛋白(ALB)的含量升高;选择性断流组各指标变化更明显,数值更接近于正常水平(P<0.05)。结论:与传统断流方法比,选择性肝血流阻断法能够减少剩余肝脏的再灌注损伤,有利于提高手术效果。但该方法存在一定局限,应根据患者实际情况选择断流方式。
Objective: To investigate the safety and efficacy of three different methods of hepatic blood flow occlusion for laparoscopic partial hepatectomy and to provide reference for hepatobiliary surgery. Methods: The clinical data of 83 patients with hepatic tumor undergoing partial hepatectomy in our hospital from July 2011 to September 2013 were analyzed. According to the way of blocking hepatic blood flow, the selected cases were divided into three groups: intermittent disconnection group (22 cases), complete disconnection group (28 cases) and selective disconnection group (33 cases). The operation time, flow-off time, intraoperative blood loss, blood transfusion, postoperative changes of liver function and the incidence of complications were observed and compared. Results: There was no significant difference between the three groups in the mean operative time and the time of discontinuation (P> 0.05). The patients with selective hepatic vascular occlusion had significantly less intraoperative and postoperative bleeding and transfusion volume (P <0.05). Complications occurred after operation in all three kinds of disconnection methods, but the incidence of complications after selective occlusion was significantly lower than that of intermittent disconnection and complete disconnection, the difference was statistically significant (P <0.05). The levels of serum total bilirubin (TBIL), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in all three groups decreased to some extent and the content of serum albumin (ALB) increased. Selective disconnection group indicators more obvious changes, the values closer to the normal level (P <0.05). Conclusion: Compared with the traditional method of disconnection, the selective hepatic blood flow blocking method can reduce the reperfusion injury of the remaining liver, which is beneficial to improve the surgical effect. However, this method has some limitations, it should be based on the actual situation of patients choose to stop flow.