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目的探讨右半肝血流阻断在肝右后叶解剖性切除术中的应用价值。方法回顾性分析2010年1月至2015年2月在湖南省人民医院行肝右后叶解剖性切除术的81例患者临床资料。根据肝脏血流阻断方法将患者分为3组,其中右半肝血流阻断法(Ⅰ法)组26例,男12例,女14例;平均年龄(48±9)岁;右后叶区域阻断法(Ⅱ法)组34例,男15例,女19例;年龄(48±10)岁;Pringle法(Ⅲ法)组21例,男10例,女11例;年龄(48±10)岁。所有患者均签署知情同意书,符合医学伦理学规定。Ⅰ法放置右半肝蒂阻断带备用,或解剖出肝右动脉及门静脉右支分别阻断。Ⅱ法在Ⅰ法基础上分离出肝右动脉右后支及门静脉右后支,结扎切断。Ⅲ法不解剖第一肝门。观察3组患者的手术时间、术中出血量、输血情况等情况。3组数据的比较采用单因素方差分析和LSD-t检验。结果Ⅰ、Ⅱ、Ⅲ法组患者的手术时间分别为(168±52)、(216±39)、(193±43)min,Ⅰ法组的手术时间明显短于Ⅱ法组和Ⅲ法组(LSD-t=-4.093,-1.772;P<0.05)。Ⅰ、Ⅱ、Ⅲ法组患者的术中出血量分别为(200±62)、(403±38)、(303±37)ml,Ⅰ法组的术中出血量明显少于Ⅱ法组和Ⅲ法组(LSD-t=-15.671,-12.735;P<0.05)。结论肝右后叶解剖性切除术中采用右半肝血流阻断控制出血安全、可行,能明显减少术中出血量,缩短手术时间,有利于降低手术风险。
Objective To investigate the value of right hepatic artery blood flow occlusion in anatomical resection of right posterior lobectomy. Methods The clinical data of 81 patients who underwent anatomical resection of the right posterior lobectomy in Hunan Provincial People’s Hospital from January 2010 to February 2015 were retrospectively analyzed. The patients were divided into 3 groups according to the method of blocking blood flow in the liver. Among them, there were 26 cases in the right hepatic blood flow blocking method (Ⅰ method), 12 males and 14 females with an average age of (48 ± 9) years; There were 34 males and 15 females, 19 females, 48 ± 10 years old, 21 males and 10 females with Pringle method (Ⅲ) ± 10) years old. All patients signed informed consent, in line with medical ethics rules. Ⅰ law placed right hemi-pedicle block with spare, or dissected the right hepatic artery and right portal vein were blocked. Ⅱ method in Ⅰ method based on the separation of the right posterior branch of the right hepatic artery and portal vein right posterior branch, ligation and cut off. Ⅲ method is not anatomical first hilar. The operation time, blood loss and blood transfusion in 3 groups were observed. Three groups of data were compared using one-way ANOVA and LSD-t test. Results The operation time of patients in group Ⅰ, Ⅱ and Ⅲ were (168 ± 52) and (216 ± 39) and (193 ± 43) min, respectively. The operation time of group Ⅰ was significantly shorter than that of group Ⅱ and group Ⅲ LSD-t = -4.093, -1.772; P <0.05). The bleeding volume in group Ⅰ, Ⅱ and Ⅲ was (200 ± 62), (403 ± 38) and (303 ± 37) ml, respectively. The amount of bleeding in group Ⅰ was less than that in group Ⅱ and Ⅲ Method group (LSD-t = -15.671, -12.735; P <0.05). Conclusion It is feasible and feasible to control the hemorrhage in the right posterior lobectomies by using the block of the right hepatic artery to reduce the intraoperative blood loss, shorten the operation time and reduce the operation risk.