【摘要】 目的:比较原发性肝细胞癌(HCC)切除术中采用全入肝血流阻断法(Pringle法)与半入肝血流阻断法(HHO法)的临床效果。方法:回顾性分析2012年1月—2016年12月期间141例行肝切除术的HCC患者临床资料,其中71例术中采用Pringle法阻断入肝血流(Pringle组),70例采用HHO法阻断入肝血流(HHO组),比较两组患者的相关临床指标。结果:两组患者术前基线资料无统计学差异(均P>0.05)。HHO组手术时间明显长于Pringle组(P=0.001),但其他临床指标包括术中出血量、输血量以及输血比率、肝实质切除范围、术后住院时间、并发症发生率两组间差异均无统计学意义(均P>0.05);术后病理方面,两组除脉管癌栓比例有统计学差异外(P=0.022),其余指标差异均无统计学意义(均P>0.05)。在乙型肝炎、肝硬化、肝实质大范围切除患者的分层分析中,HHO组手术时间均明显长于Pringle组(均P<0.05);HHO组术后多数肝功能指标优于Pringle组,但仅在肝炎患者中术后第7天白蛋白(ALB)水平及肝实质大范围切除患者中术后第7天ALB、术后第5天谷草转氨酶水平差异有统计学意义(均P<0.05),其余各项肝功能指标及其他临床指标两组间差异均无统计学意义(均P>0.05)。结论:HCC肝切除术中,两种入肝血流阻断法均是安全有效的,但合并肝炎、肝硬化或肝实质大范围切除的患者,推荐采用HHO法行入肝血流阻断。更多还原

【Abstract】 Objective: To compare the clinical effects of total hepatic inflow occlusion(Pringle’s maneuver) and hemihepatic inflow occlusion(HHO) in hepatectomy for hepatocellular carcinoma(HCC). Methods: The clinical data of 141 patients with HCC undergoing liver resection from January 2012 to December 2016 were analyzed retrospectively. Of the patients, 71 cases underwent hepatic inflow occlusion with Pringle’s maneuver(Pringle group) and 70 cases underwent hepatic inflow occlusion with HHO method(HHO group). The main clinical variables between the two groups of patients were compared. Results: There were no significant differences in the baseline data between the two groups of patients(all P>0.05). The operative time in HHO group was significantly longer than that in Pringle group(P=0.001), but no significant differences were noted in other clinical variables that included intraoperative blood loss, amount of blood transfusion, proportion needing blood transfusion, liver resection scope, length of postoperative hospital stay and incidence of postoperative complications between the two groups(all P>0.05). In terms of postoperative pathology, all variables except the presence of vessel tumor emboli(P=0.022) showed no significant differences between the two groups(all P>0.05). In the stratification analyses of patients with hepatitis B, liver cirrhosis or major liver resection, the operative times in HHO group were all significantly longer than those in Pringle group(all P<0.05); the majority of postoperative liver function parameters in HHO group were superior to those in Pringle group, but only the differences of albumin levels on postoperative day(POD) 7 in patients with hepatitis B and the ALB levels on POD 7 and aspartate aminotransferase levels on POD 5 in patients with major liver resection had statistical significance(all P<0.05), all differences in the remaining liver function parameters and other clinical variables did not reach a statistical significance(all P>0.05).Conclusion: In hepatectomy for HCC, both methods for hepatic inflow occlusion are safe and effective. However, in those with hepatitis, cirrhosis or major hepatectomy, HHO method is recommended for hepatic inflow occlusion.更多还原