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目的对肝切除过程中实施肝门血流阻断方法进行深入探讨。方法通过检索中国医院知识仓库全文数据库、MEDLINE相关文献对肝门血流阻断的方法进行分类,并客观评估每种方法的利弊。结果 Pringle法是最早应用于肝切术手术时控制肝断面失血量的方法,此法简单、易行,也是目前临床应用最广泛的一种方法,但是时间不宜过长,否则会对肝脏产生严重的缺血再灌注损伤,尤其对肝脏本身存在基础病变的患者;全肝血流阻断有很好的手术中控制失血量的效果,但是缺血再灌注损伤应引起重视;半肝血流阻断和保留肝动脉的半肝血流阻断方法一定程度上减轻了肝脏缺血再灌注损伤,但是只能应用于手术操作位于一侧半肝的患者,应用范围受到一定局限;肝段血流阻断法对肿瘤较小且局限于一个肝段或相邻几个肝段的手术操作是一种理想的阻断方法,但是由于操作复杂,定位困难,只能在一些医疗条件较好,且具备熟练解剖知识的高年资外科医生中开展。结论实施肝门血流阻断,控制肝断面失血量是肝脏手术中的一项重要技术,目前临床应用的肝门控制方法各有利弊,探索一种既有较好的止血效果,又最大限度的减少因阻断对肝脏产生损伤和对全身血流动力学影响的入肝血流阻断方法,仍然需要深入的研究和探讨。
Objective To investigate the method of hepatic vascular blockade during hepatectomy. Methods By searching the full-text database of Chinese hospital knowledge warehouse, MEDLINE related documents were used to classify the methods of hepatic portal blood flow occlusion and to objectively evaluate the advantages and disadvantages of each method. Results Pringle method is the earliest method used to control the blood loss of hepatic sections in liver resection surgery. This method is simple and easy, and is the most widely used method at present. However, the time should not be too long, otherwise the liver will be severely damaged Especially in patients with underlying liver disease itself; whole blood flow occlusion has a good surgical control of blood loss, but ischemia-reperfusion injury should pay attention; hemi-resistance The method of blocking and retaining the hepatic artery in the hemihepatic blood flow relieves the liver ischemia-reperfusion injury to a certain extent, but it can only be used in the operation of the patients with the hemihepatic liver on one side, the application scope is limited. The hepatic segment blood flow Blocking surgery for small tumors and limited to a liver segment or adjacent liver segment of the surgical operation is an ideal method of blocking, but because of the complexity of the operation, positioning difficulties, only in some medical conditions, and Senior surgeons with good anatomical knowledge are among the surgeons. Conclusion The implementation of hepatic portal vein occlusion and blood loss control of hepatic sections is an important technique in liver surgery. At present, the clinical approaches to hepatic portal control have their own advantages and disadvantages, and both have a better hemostatic effect and the maximum To reduce the blocking of liver damage and systemic hemodynamic effects of hepatic blood flow blocking methods still need further study and discussion.