肝静脉阻断技术在肝切除术中的应用.doc

1 肝静脉阻断技术在肝切除术中的应用作者:周伟平李爱军傅思源杨远吴孟超【摘要】目的探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用。方法对 105 例肝脏肿瘤手术切除患者施行了1 根以上主肝静脉阻断。所有肿瘤均位于第二肝门并侵犯或压迫 1 根以上主肝静脉。肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法。结果 105 例中无一例肝静脉分离破裂。施行半肝全血流阻断 41例( 右侧 27例, 左侧 14例), 交替半肝全血流阻断 4 例,第一肝门阻断加部分肝静脉阻断 45 例,第一肝门阻断加全部肝静脉阻断( 不阻断下腔静脉的全肝血流阻断)15 例。其中 46 例同时行第三肝门分离。 105 例肿瘤顺利切除。结论肝静脉阻断技术是一种安全、有效的血流阻断技术。不阻断下腔静脉的全肝血流阻断术既能控制术中出血,又能保证全身血流动力学稳定。【关键词】肝肿瘤; 肝切除术; 肝静脉阻断 2 【 Abstract 】 Objective To evaluate the effect of hepatic vEins occlusion on prevention of bleeding and air embolism in liver rupture during resection plicated liver tumors. Methods A total of 105 cases with liver tumors underwent resection with more than one main hepatic vEIns occlusion. All tumors involved the second porta hepatis and at lest one main hepatic veins. Ligation or occlusion with serrefine, tourniquet and auricular clamp were used in hepatic veins occlusion. Results Liver resection was essful in all 105 cases, with no hepatic veins rupture. Of all, 41 cases were treated with hemihepatic vascular occlusion, 4 with alternative hemihepatic vascular occlusion, 45 with both the Pringle ′s maneuver and selective hepatic veins occlusion and 15 with both the Pringle ′s maneuver and total hepatic veins occlusion. In 46 cases, the third porta hepatis was isolated. Conclusions Hepatic veins occlusion in the hepatectomy isa safe and effective technique of blood occlusion. Whole liver blood occlusion technique without occluding inferior vena cava can prevent bleeding and air embolism. 【 Key words 】 Liver tumors; Hepatectomy; Hepatic veins occlusion 3 第二肝门区肿瘤手术最严重的并发症之一是肝静脉破裂导致的大出血或空气栓塞[1]。以往防止肝静脉破裂出血的有效手段是采用全肝血流阻断法切肝, 但可能造成全身血流动力学紊乱[2]。采用肝外分离阻断肝静脉技术既可达到防止术中肝静脉破裂出血, 又能避免全肝血流阻断术引起的全身血流动力学紊乱[ 3]。 2003 年1 月至 2005 年9 月,我们共施行肝叶切除术 603 例, 其中采用肝静脉阻断技术切除第二肝门区肿瘤 105 例, 手术全部成功, 无一例发生肝静脉破裂出血。 1 资料和方法 临床资料 105 例肝静脉阻断术中男 80例,女 25例; 平均年龄 53岁(4~ 71岁) 。原发性肝细胞癌 71 例,肝母细胞瘤 2 例,肝胆管细胞癌 3例, 转移性肝癌 3例, 肝肉瘤 1例, 肝海绵状血管瘤 22例, 肝局灶性结节增生 2例, 肝血管平滑肌脂肪瘤 1 例。全部肿瘤均位于第二肝门且侵犯或压迫 1 根以上主肝静脉,同时紧