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目的探讨原发性肝癌部分肝脏切除术中长时限持续性应用肝门阻断法的安全性,分析其与间断性肝门阻断法的效果差异。方法采用回顾性分析方法,选取2014年1月至2015年1月收治的采用入肝血流阻断部分肝脏切除术治疗的原发性肝癌患者86例为研究对象,根据血流阻断方式不同,将患者分为持续阻断组39例和间断阻断组47例。两组采用同样的手术方式,但在入肝血流阻断时,间断阻断组每阻断15 min后复流5 min,之后重复直至手术完成;持续阻断组阻断时间最长为50 min,超过50 min后复流,并根据术中情况再行阻断。比较两组手术情况、术后肝功能影响及并发症发生情况。结果两组患者累计总阻断时间无统计学差异(P>0.05),但持续阻断组手术时间及术中出血量低于间断阻断组,而创面对拢者比例高于间断阻断组(P均<0.01),持续阻断组术后1、3、7 d TBIL水平低于间断阻断组,术后AST水平在1、3 d低于间断阻断组,差异具有统计学意义(P均<0.05),术后并发症发生率及住院时间两组比较,差异无统计学意义(P均>0.05)。结论原发性肝癌患者部分肝脏切除术可以安全耐受持续性长时限肝门阻断法血流阻断,相对间断性血流阻断法,超过30 min持续阻断对剩余肝实质损伤无明显增加,且降低了术后输血量。
Objective To investigate the safety of long-term continuous hepatic hilar blockade in partial hepatectomy of primary hepatocellular carcinoma (HCC) and analyze the difference between the two methods. Methods A retrospective analysis method was used to select 86 patients with primary liver cancer treated by partial hepatectomy with hepatic blood flow admitted from January 2014 to January 2015. According to the different ways of blocking blood flow The patients were divided into continuous blocking group (39 cases) and intermittent blocking group (47 cases). The same surgical procedure was used in both groups. However, in the blocking of hepatic blood flow, the patients in intermittent blocking group re-flow for 5 minutes after blocking for 15 minutes and then repeating until the operation was completed. The longest blocking time in continuous blocking group was 50 min, more than 50 min after the reflow, and block again under the circumstances. The operative conditions, postoperative liver function and complication were compared between the two groups. Results There was no significant difference in cumulative total occlusion time between the two groups (P> 0.05). However, the duration of operation and the amount of intraoperative blood loss in the continuous block group were lower than those in the intermittent block group, Group (all P <0.01). The level of TBIL in the continuous block group was lower than that in the intermittent block group at 1, 3 and 7 days after operation, and the postoperative AST level was lower than that in the intermittent block group at 1 and 3 days (P <0.05). The incidence of postoperative complications and hospital stay were not significantly different between the two groups (P> 0.05). Conclusion Partial hepatectomy of patients with primary liver cancer can safely withstand blood flow interruption by continuous long-term portal hepatic hilar blockade. Relatively intermittent blood flow blockade, continuous blocking over 30 minutes has no obvious effect on the remaining liver parenchymal injury Increase, and reduce postoperative blood transfusion.