Ⅰ、Ⅱ级肝门区域阻断肝叶(段)切除的初步体会

目的 总结区域阻断肝叶、肝段的入肝血管分支,施行各种类型肝切除的经验.方法 回顾性分析2006年～2007年间湖南省人民医院肝胆科行肝门区域血管阻断肝部分切除的319例临床资料.左肝外叶切除127例,左半肝切除(含Ⅰ段切除)89例,右肝前叶切除15例,右肝后叶切除34例,右半肝切除(含Ⅸ段切除)32例,肝血管瘤剥除/肝局部切除19例,肝囊肿剥除/肝局部切除3例.结果 全组无手术死亡,失血量平均(70±15)mL,术后5～7 d复查肝功能无明显损害,未出现肝坏死、胆漏、出血等并发症.结论 区域血管阻断肝叶(段)切除避免了保留肝叶的缺血再灌注损伤,使手术从容不迫的进行,减少了大量失血及肝功能衰竭的发生,是一种安全、有效的切肝手术方法.

Hepatic seginentectomy by regional vascular occlusion at hepatic hilum

Objective To study the experience on a variety of hepatectomy by occluding the branches of hepatic artery and portal vein to the liver lobe,segment at hilar H fissure.Methods A total of three hun-dred and ninteen patients accepted hepatectomy in Hunan provincial people's hospital from Decemember 2006 to Decemember 2007 were involved in this study for retrospective analysis.Results There were no perioperative deaths and liver function failure in this series of patients.The average amount of blood loss was 70 15ml,and 302 (95 %)cases did not receive transfusion.Postoperative complications such as liver necro-sis,bile leaking,bleeding were not found.Subphrenic abscesses were found in 3 cases,which were cured conservatively.Conclusion Selective regional occlusion of hepatic blood flow during bepatectomy avoided the risk of ischemia-reflow injury of remnant liver,which is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.