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目的:评价肝硬化患者行肝脏肿瘤切除术时肝血流阻断方法的选用。方法:将我院2007年6月—2012年12月63例需行肝切除的肝肿瘤伴肝硬化患者随机分为3组。A组22例,为间歇血流阻断组,采用阻断肝血流15 min,复流5 min;B组20例,为半肝血流阻断组,行同侧半肝血流持续性阻断,健侧血流正常;IP组21例,采用入肝血流阻断前先阻断5 min、复流5 min的预处理方法。比较3组术中阻断时间、肝断面单位面积出血量、3组及3组中阻断时间<30 min者术后1、3、7、14 d的ALT、AST及TB变化情况。结果:3组肝断面单位面积出血量差异有统计学意义(P<0.05)。术后B组缺血再灌注损伤最轻,IP组最重,差异有统计学意义(P<0.05)。阻断时间<30min者术后肝功比较,IP组较A组缺血再灌注损伤明显降低(P<0.05)。结论:肝血流阻断前预处理可减少肝切除术中的失血量。术前预计切除时间<30 min的患者可采用预处理减少出血量及再灌注损伤。
Objective: To evaluate the method of hepatic blood flow occlusion during liver tumor resection in patients with liver cirrhosis. Methods: Sixty-three cases of liver tumor with cirrhosis who underwent hepatectomy in our hospital from June 2007 to December 2012 were randomly divided into three groups. A group of 22 patients, intermittent blood flow blocking group, the blocking of hepatic blood flow for 15 min, re-flow 5 min; B group of 20 patients, the hemihepatic flow block group, the ipsilateral half-liver blood flow continuity Blocking and contralateral blood flow were normal.The IP group consisted of 21 patients. The pretreatment was blocked for 5 min and reflowed for 5 min before hepatic blood flow was blocked. The changes of ALT, AST and TB at 1, 3, 7 and 14 days after operation were compared between the three groups in the blocking time, the hemorrhage per unit area of liver section, and the blocking time of <30 min in group 3 and group 3. Results: There were significant differences in bleeding volume per unit area between the three groups (P <0.05). The postoperative ischemia and reperfusion injury was the lightest in group B, the heaviest in IP group, the difference was statistically significant (P <0.05). After blocking the time <30min, the liver function in the IP group was significantly lower than that in the A group (P <0.05). Conclusions: Pretreatment of hepatic blood flow before occlusion reduces blood loss during hepatectomy. Preoperative removal of patients is expected to <30 min pretreatment can be used to reduce bleeding and reperfusion injury.