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目的:比较前入路绕肝提拉法和常规法肝切除在右半肝切除术中应用的安全性和临床可行性。方法:选择2008年1月—2011年6月间收治的拟行右半肝切除患者40例,随机分为常规肝切除组(n=20)和前入路绕肝提拉法肝切除组(n=20),比较两组患者术前情况、肝切除范围、术中情况、术后并发症及各项生化指标的变化。结果:两组患者术前一般资料和肝切除范围具有可比性;术中大出血发生率两组间无差异(P>0.05),但绕肝提拉法组术中出血量和输血量均明显少于常规法组[(340.0±241.4)mLvs.(725.0±386.6)mL;(290.0±397.2)mL vs.(615.0±722.7)mL,均P<0.05],且绕肝提拉法组中未输血患者比例明显高于常规法组(16/20 vs.10/20,P<0.05);两组患者ICU时间、住院时间及术后并发症发生率无差异(均P>0.05);两组间术前及术后第1天肝功能指标[总胆红素(TBIL),谷丙转氨酶(ALT),谷草转氨酶(AST),前白蛋白(PA),凝血酶原时间(PT)]差异均无统计学意义(均P>0.05),但常规法组术后第1天C反应蛋白(CRP),术后第3,5,7天TBIL,ALT,AST,PT均明显高于前入路绕肝提拉法组,PA明显低于前入路绕肝提拉法组(均P<0.05);两组间肾功能指标(尿素氮,肌酐)术前、术后均无明显差异(均P<0.05)。结论:前入路绕肝提拉法应用于右半肝切除术较常规法在术中安全及保护术后肝功能方面更有优势。
Objective: To compare the safety and clinical feasibility of anterior hepatectomy and conventional hepatectomy in right hemihepatectomy. Methods: Forty patients underwent right hepatic resection between January 2008 and June 2011 were randomly divided into conventional hepatectomy group (n = 20) and anterior approach hepatectomy group n = 20). The preoperative conditions, the range of hepatectomy, intraoperative conditions, postoperative complications and biochemical indexes were compared between the two groups. Results: There was no difference between the two groups in the general preoperative data and the range of hepatic resection. The incidence of intraoperative hemorrhage was no significant difference between the two groups (P> 0.05). (340.0 ± 241.4) mLvs. (725.0 ± 386.6) mL; (290.0 ± 397.2) mL vs. (615.0 ± 722.7) mL, all P <0.05] (16/20 vs10 / 20, P <0.05). There was no difference in ICU time, hospital stay and postoperative complications between the two groups (all P> 0.05) The indexes of liver function (TBIL, ALT, AST, PA, PT) on the first day after operation were (P> 0.05). However, C reactive protein (CRP), TBIL, ALT, AST and PT on the 1st day after operation in the conventional group were significantly higher than those on the anterior approach PA around the liver, PA was significantly lower than the anterior approach around the liver Ctilactac group (all P <0.05); between the two groups renal function indicators (urea nitrogen, creatinine) before and after surgery were no significant difference (both P <0.05). CONCLUSION: The anterior approach of the Czochralshala method for right hemihepatectomy has more advantages than conventional methods in the safety of operation and protection of postoperative liver function.