【摘要】 目的探讨原发性肝癌患者行肝切除术中不阻断肝血流对肝功能及术后恢复的影响。方法将2010年6月-2013年6月福建省立医院收治的80例行肝切除术的原发性肝癌患者依据肝血流阻断方法的不同分为3组:第一肝门阻断组(Pringle组,n=24)、半肝血流阻断组(HVC组,n=24)及不阻断肝血流组(n=32)。分别比较不阻断肝血流组与Pringle组和HVC组患者的手术时间、术中出血量、术后肝功能变化、手术并发症及术后住院时间。计量资料和计数资料分别采用方差分析及卡方检验,方差分析中多重比较采用Dunnett-t检验。结果 3组患者手术时间、出血量差异均无统计学意义(F值分别为2.45,0.34,P值均>0.05)。术后1及7 d血清TBil及ALT恢复情况,不阻断肝血流组[1 d,TBil:(22.4±9.4)μmol/L,ALT:(287.4±165.7)U/L;7 d,TBil:(17.1±6.6)μmol/L,ALT:(86.2±54.5)U/L]优于Pringle组[1 d,TBil:(33.5±11.9)μmol/L,ALT:(429.5±137.8)U/L;7 d,TBil:(24.5±7.0)μmol/L,ALT:(145.5±43.6)U/L]及HVC组[1d,TBil:(29.1±8.3)μmol/L,ALT:(390.2±176.6)U/L;7 d,TBil:(21.5±7.5)μmol/L,ALT:(121.5±56.8)U/L](P值均<0.05)。血清Alb恢复情况,术后1 d,不阻断肝血流组[(29.3±2.8)g/L]优于Pringle组[(27.3±3.3)g/L](P值均<0.05),但与HVC组[(27.8±2.5)g/L]相比,差异无统计学意义(P>0.05);术后7 d,3组患者差异均无统计学意义(P值均>0.05)。不阻断肝血流组术后住院时间[(10.3±2.1)d]较Pringle组[(12.7±2.6)d]和HVC组[(12.0±2.2)d]显著缩短(P值均<0.05)。结论不阻断肝血流较第一肝门阻断、半肝血流阻断,不增加手术时间及术中出血量,且具有肝损伤较轻及术后恢复快的优点。更多还原

【Abstract】 Objective To investigate the effects of hepatectomy without hepatic blood flow occlusion( HBFO) on the liver function and postoperative recovery in patients with primary liver cancer. Methods Eighty patients with primary liver cancer who underwent hepatectomy in our hospital from June 2010 to June 2013 were divided into three groups: first porta hepatis control( Pringle) group( n = 24),hemihepatic vascular control( HVC) group( n = 24),and non-HBFO group( n = 32). The operation time,intraoperative blood loss,postoperative liver function,surgical complications,and postoperative length of hospital stay were compared between the three groups. Categorical data were analyzed by chi-square test,and continuous data were analyzed using ANOVA followed by Dunnett-t for multiple comparisons. Results There were no significant differences in the operation time and intraoperative blood loss between the three groups( F = 2. 45 and 0. 34,P > 0. 05 for both). The recovery of serum total bilirubin( TBil) and alanine aminotransferase( ALT) at 1 and 7 d after operation was significantly better in the non-HBFO group( 1 d,TBil: 22. 4 ± 9. 4 μmol /L,ALT: 287. 4 ± 165. 7 U /L; 7 d,TBil: 17. 1 ± 6. 6 μmol /L,ALT: 86. 2 ± 54. 5 U /L) than in the Pringle group( 1 d,TBil: 33. 5 ± 11. 9 μmol /L,ALT: 429. 5 ± 137. 8 U /L; 7 d,TBil: 24. 5 ± 7. 0 μmol /L,ALT: 145. 5 ± 43. 6 U /L)and HVC group( 1d,TBil: 29. 1 ± 8. 3 μmol /L,ALT: 390. 2 ± 176. 6 U /L; 7d,TBil: 21. 5 ± 7. 5 μmol /L,ALT: 121. 5 ± 56. 8 U /L)( P <0. 05 for all). The recovery of serum albumin( Alb) at 1 d after operation was significantly better in the non-HBFO group( 29. 3 ± 2. 8 g /L)than in the Pringle group( 27. 3 ± 3. 3 g /L)( P < 0. 05),but it showed no significant difference between the non-HBFO group and HVC group( 29. 3 ± 2. 8 g /L vs 27. 8 ± 2. 5 g /L,P > 0. 05); there were no significant differences in the recovery of serum Alb at 7 d after operation between the three groups( P > 0. 05). The postoperative length of hospital stay was significantly shorter in the non-HBFO group( 10. 3 ± 2. 1d) than in the Pringle group( 12. 7 ± 2. 6 d) and HVC group( 12. 0 ± 2. 2 d)( P < 0. 05). Conclusion Compared with Pringle maneuver and HVC,non-HBFO would not increase the intraoperative blood loss and operation time and leads to milder liver function damage and more rapid postoperative recovery in patients with primary liver cancer undergoing hepatectomy.更多还原