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目的:探讨肝癌切除术中不同肝血流阻断方法的合理选择。方法:回顾性分析124例肝癌肝切除患者资料,根据术中血流阻断方法分为A组(51例行全肝入肝血流阻断),B组(38例行选择性入肝血流阻断),C组(24例行选择性出入肝血流阻断),D组(11例行半肝血流完全阻断)。比较4组患者手术时间、肝脏缺血时间、术中出血、输血量,术后肝功恢复情况、术后并发症发生率及病死率等。结果:各组间术前基本情况无统计学差异(均P>0.05)。各组在肝缺血时间、术后并发症发生率及病死率等方面无统计学差异(均P>0.05);C组和D组手术时间明显长于A组(均P<0.05),但术中出血量、输血量均少于A组和B组(均P<0.05);A组术后丙氨酸转氨酶(ALT)总胆红素(TBIL)与水平升高较为明显,前者与其余3组间差异均有统计学意义,后者与B组间差异有统计学意义(均P<0.05)。结论:肝血流阻断方法的合理选择须由肿瘤大小、位置,术前肝功能状况、潜在肝病、心脑血管状态等因素综合决定,而最重要的是依靠术者的经验与判断力。
Objective: To investigate the reasonable choice of different hepatic blood flow occlusion methods in resection of liver cancer. Methods: A retrospective analysis of 124 cases of liver cancer patients with liver resection, according to the method of intraoperative blood flow is divided into A group (51 cases of whole liver into the liver blood flow block), B group (38 cases of selective hepatic blood Flow block), group C (24 patients with selective access hepatic blood flow blocking), group D (11 patients with complete hepatic hemodynamic block). The operation time, liver ischemia time, intraoperative blood loss, blood transfusion, postoperative liver function recovery, postoperative complications and mortality were compared between the 4 groups. Results: There was no significant difference in the basic conditions between the two groups (all P> 0.05). There was no significant difference in the time of hepatic ischemia, incidence of postoperative complications and mortality (all P> 0.05). The operation time of group C and group D was longer than that of group A (all P <0.05) (P <0.05). In group A, the level of total bilirubin (ALT) and total bilirubin (TBIL) was significantly higher in group A than in group A and B The differences between the two groups were statistically significant (P <0.05). Conclusion: The rational choice of the method of hepatic blood flow occlusion should be decided by the tumor size, location, preoperative liver function, potential liver disease, cardiovascular status and other factors. The most important thing is to rely on the experience and judgment of the surgeon.