【摘要】 目的评估肝蒂联合右肝静脉阻断在巨块型肝癌切除中的作用和意义。方法对2003年2月至2006年8月中南大学湘雅二医院肝胆外科收治的138例位于右半肝及中央型的巨大肝癌行肝蒂联合右肝静脉阻断,观察肝脏血流阻断时间、手术时间、术中出血量、术后肝功能的变化及术后并发症。结果135例在肝外游离出右肝静脉并加以阻断,3例以小的心耳钳沿腔静脉方向纵行夹住右肝静脉阻断出肝血流。所有病例右侧均顺利阻断肝蒂。肝脏血流阻断时间平均为(18±6)min,手术时间平均为(180±45)min,术中出血400~1200mL,56例术中未输血。术后无一例发生肝功能衰竭。术后膈下感染2例,胆漏4例,经引流自愈。结论在巨块型肝癌切除中,肝蒂联合右肝静脉阻断技术可以有效地减少术中出血,降低术后肝功能衰竭的发生率。更多还原

【Abstract】 Objective To explore the role of right hepatic vein and hepatic pedicle exclusion in large liver tumor operation.Methods One hundred and thirty-eight patients with large hepatic carcinoma involving right hemiliver and segmentⅠ,Ⅳ,Ⅶ,Ⅷ underwent major hepatectomies,during which right hepatic vein and hepatic pedicle were isolated and taped to control blood flow between Febuary 2003 and August 2006.The blood loss volume,postoperative recovering situation of the liver function and the incidence of complication were observed.The time of hepatic vascular exclusion and the whole operate time were also recorded.Results Extrahepatic isolation and control of right hepatic vein were performed in 135 patients.Hepatic pedicle exclusions were performed successfully in all cases.The time of hepatic vascular exclusion was about (18±6) minutes,and the whole operate time was about (180±45) minutes.The amount of blood loss was from 400 to 1 200 mL.Intraoperational blood transfusion was not performed in 56 patients.There was no operative mortality and liver function failure.Conclusion Right hepatic vein and porta hepatis exclusion during hepatectomy is a safe method and effective to prevent massive bleeding and to reduce the incidence of liver function failure.更多还原