Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 杨孙虎 ¹ , 黄明哲 ¹ , 李峰 ¹ , 李坡 ² , 张振名 ²

1. ;
2. ;

Corresponding author：

杨孙虎, Email: yangsh06@126.com

Keywords：

肝切除术; 肝血流阻断

DOI：

10.7507/1007-9424.20140017

Video：

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目的探讨保留肝动脉血供的肝血流阻断对肝切除术失血量和肝功能的影响。方法回顾性分析了2007年9月至2012年12月期间上海交通大学医学院附属第三人民医院118例行肝切除术患者的临床资料，其中68例行保留肝动脉血供的肝血流阻断（保留组），50例采用Pringl法行肝门阻断（阻断组），比较2组的手术失血量、接受输血病例的比例、手术并发症以及术后肝功能恢复情况。结果全组无围手术期死亡病例。保留组患者的平均手术时间、术中失血量、接受输血患者的比例、术后肠道功能恢复时间以及术后并发症发生率与阻断组相比差异均无统计学意义（P＞0.05）；术后第1天及第5天，谷丙转氨酶及谷草转氨酶水平保留组明显低于阻断组（P＜0.05）。结论保留肝动脉血供的肝血流阻断法能有效控制肝断面出血，明显保护了肝脏功能，且并未延长手术时间。

Citation： 杨孙虎, 黄明哲, 李峰, 李坡, 张振名. Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 85-88. doi: 10.7507/1007-9424.20140017 Copy

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11.	郑瑞国, 窦科峰, 李军, 等.选择性保留半肝动脉血供的肝血流阻断法在肝癌肝切除术中的应用[J].第四军医大学学报, 2009, 30(8):749-752.
12.	屠克伞, 梁传芳, 伦增军, 等.人体常温下阻断和恢复入肝血流后肝组织病理与超微结构的临床研究[J].中国普外基础和临床研究, 1998, 5(4):226-227.
13.	Mücke I, Richter S, Menger MD, et al.Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers[J].Int J Colorectal Dis, 2000, 15(5-6):335-341.
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15.	胡建军, 李崇辉, 王洪东, 等.保留肝动脉人肝血流阻断法对肝硬化大鼠肝脏的保护作用[J].中华肝胆外科杂志, 2013, 19(1):62-65.

1. Smyrniotis V, Favantos C, Kostopanagiotou G, et al.Vascular control during hepatectomy:review of methods and results[J].World J Surg, 2005, 29(11):1384-1396.
2. Kooby DA, Stockman J, Ben-Porat L, et al.Influence of trans-fusions on perioperative and long-term outcome in patients follo-wing hepatic resection for colorectal metastases[J].Ann Surg, 2003, 237(6):860-869.
3. Torzilli G, Makuuchi M, Midorikawa Y, et al.Liver resection without total vascular exclusion:hazardous or beneficial? An analysis of our experience[J].Ann Surg, 2001, 233(2):167-175.
4. 王义, 陈科济, 张友磊, 等.原发性肝癌肝切除术中延长肝门阻断时限的探讨[J].中华外科杂志, 2008, 46(10):776-779.
5. Hannoun L, Borie D, Delva E, et al.Liver resection with normo-thermic ischaemia exceeding 1 h[J].Br J Surg, 1993, 80(9):1161-1165.
6. Kim YI, Nakashima K, Toda I, et al.Prolonged normothermic ischaemia of human cirrhotic liver during hepatectomy:a preliminary report[J].Br J Surg, 1993, 80(12):1566-1570.
7. Bismuth H.Surgical anatomy and anatomical surgery of the liver[J].World J Surg, 1982, 6(1):3-9.
8. Oda M, Yokomori H, Han jY.Regulatory mechanisms of hepatic microcircuiation[J].Clin Hemorheol Microcirc, 2003, 29(1-2):167-182.
9. 熊奇如, 耿小平.半肝血流阻断在肝切除术的临床应用[J].安徽医科大学学报, 2004, 39(1):42-44.
10. 严律南, 袁朝新, 张肇达, 等.应用半肝血流阻断行肝叶切除术29例报告[J].中华外科杂志, 1994, 32(1):35-36.
11. 郑瑞国, 窦科峰, 李军, 等.选择性保留半肝动脉血供的肝血流阻断法在肝癌肝切除术中的应用[J].第四军医大学学报, 2009, 30(8):749-752.
12. 屠克伞, 梁传芳, 伦增军, 等.人体常温下阻断和恢复入肝血流后肝组织病理与超微结构的临床研究[J].中国普外基础和临床研究, 1998, 5(4):226-227.
13. Mücke I, Richter S, Menger MD, et al.Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers[J].Int J Colorectal Dis, 2000, 15(5-6):335-341.
14. Richter S, Mücke I, Menger MD, et al.Impact of intrinsic blood flow regulation in cirrhosis:maintenance of hepatic arterial buffer response[J].Am J Physiol Gastrointest Liver Physiol, 2000, 279(2):G454-G462.
15. 胡建军, 李崇辉, 王洪东, 等.保留肝动脉人肝血流阻断法对肝硬化大鼠肝脏的保护作用[J].中华肝胆外科杂志, 2013, 19(1):62-65.

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Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy

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